WASHINGTON, D.C. – Senators Thom Tillis, John Cornyn (R-TX), Tom Carper (D-DE), and Sherrod Brown (D-OH) recently introduced the Share the Savings with Seniors Act, which would lower out-of-pocket prescription drug costs for seniors with chronic health conditions.
“Seniors with chronic conditions oftentimes face unnecessarily high out-of-pocket costs,” said Senator Tillis. “We must address misaligned incentives that artificially drive up prescription drug prices, and I’m proud to work with my colleagues to reduce out-of-pocket costs and ensure seniors have uninterrupted access to evidence-based medicines.”
The Share the Savings with Seniors Act would:
Currently, drug manufacturers who want to be on a particular formulary pay rebates varying in amount depending on the results of negotiation with the pharmacy benefit manager (PBM) or insurer. This negotiation is based off the list price of the drug. PBMs and insurers often require that patients pay cost sharing based on the full list price of medicines – not the net price negotiated by the PBM or insurer – when filling prescriptions in the deductible or for prescriptions subject to coinsurance. This increases costs for patients at the pharmacy counter and can even lead to patients paying more for a medicine than their insurer did.
This legislation would require full rebate pass-through for chronic condition medicines in the deductible or when patients owe coinsurance and ensure that the patients who are most likely to face high out-of-pocket costs directly benefit from the savings that PBMs and plans negotiate on their behalf. This would lead to greater patient savings at the pharmacy counter. By targeting specific chronic conditions, this bill is focused on medicines with the best evidence of improved adherence and would lead to lower utilization of non-drug medical services like fewer hospital stays and provider visits. Additionally, this legislation targets all medicines within a therapeutic class to help prevent misaligned incentives for plans to cover particular medicines based on their individual rebate level.