Protecting Patient Access to Cancer and Complex Therapies Act | ChamberLight
Bills · HR 4299
IN COMMITTEE· 119TH CONGRESS
House BillHR 4299Health
Protecting Patient Access to Cancer and Complex Therapies Act
INTRO JUL 7· LAST ACTION JUL 7
READING
9MIN
COSPONSORS
29BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it directly impacts how much Medicare patients pay for some of their most expensive prescription drugs, especially those used for serious conditions like cancer. If it becomes law, patients could see lower out-of-pocket costs for these specific medications because their coinsurance would be based on the government's negotiated price, rather than the typically higher market price. This could make life-saving treatments more affordable and accessible.
For the healthcare system, this bill creates a new mechanism for drug manufacturers to return money to Medicare for drugs subject to price negotiation. While Medicare would still initially pay providers a higher rate, the rebate system aims to ensure the program ultimately benefits from the negotiated prices, and that patients feel that benefit directly at the pharmacy counter. Without this bill, patient out-of-pocket costs for these drugs might continue to be based on higher market prices, even with federal price negotiations in place.
KEY PROVISIONS
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PROVISION 01
Removes existing language that would reduce Medicare Part B payments for "selected drugs" based on maximum fair price negotiation.
This ensures that healthcare providers continue to receive payments based on the average sales price plus a markup.
PROVISION 02
Establishes a new system requiring drug manufacturers to pay a quarterly rebate to Medicare for "selected drugs" subject to maximum fair price negotiation.
This recovers the difference between what Medicare pays providers and the lower negotiated price from manufacturers.
PROVISION 03
Calculates Medicare Part B beneficiary coinsurance for "selected drugs" based on the maximum fair price plus 6% (MFP+6).
This directly reduces out-of-pocket costs for patients receiving these high-cost drugs.
PROVISION 04
Applies existing civil money penalties for manufacturers who fail to comply with the new rebate requirements.
This provides enforcement mechanisms to ensure manufacturers pay the required rebates.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill matters because it directly impacts how much Medicare patients pay for some of their most expensive prescription drugs, especially those used for serious conditions like cancer. If it becomes law, patients could see lower out-of-pocket costs for these specific medications because their coinsurance would be based on the government's negotiated price, rather than the typically higher market price. This could make life-saving treatments more affordable and accessible.
For the healthcare system, this bill creates a new mechanism for drug manufacturers to return money to Medicare for drugs subject to price negotiation. While Medicare would still initially pay providers a higher rate, the rebate system aims to ensure the program ultimately benefits from the negotiated prices, and that patients feel that benefit directly at the pharmacy counter. Without this bill, patient out-of-pocket costs for these drugs might continue to be based on higher market prices, even with federal price negotiations in place.
KEY PROVISIONS
AI-extracted
med
Removes existing language that would reduce Medicare Part B payments for "selected drugs" based on maximum fair price negotiation.
This ensures that healthcare providers continue to receive payments based on the average sales price plus a markup.
high
Establishes a new system requiring drug manufacturers to pay a quarterly rebate to Medicare for "selected drugs" subject to maximum fair price negotiation.
This recovers the difference between what Medicare pays providers and the lower negotiated price from manufacturers.
high
Calculates Medicare Part B beneficiary coinsurance for "selected drugs" based on the maximum fair price plus 6% (MFP+6).
This directly reduces out-of-pocket costs for patients receiving these high-cost drugs.
med
Applies existing civil money penalties for manufacturers who fail to comply with the new rebate requirements.
This provides enforcement mechanisms to ensure manufacturers pay the required rebates.
The civil money penalty established under paragraph (7) of subsection (i) of Section 1847A of the Social Security Act
Manufacturers who fail to comply with the rebate requirements
GLOSSARY
AI-written
Selected drug
Certain high-cost prescription drugs identified by Medicare as being eligible for price negotiation, typically those that have been on the market for some time and lack generic competition.
Maximum fair price negotiation
A process where the government negotiates a lower price with drug manufacturers for specific high-cost drugs covered by Medicare.
Rebate
A partial refund or payment returned to a purchasing entity (in this case, Medicare) by a manufacturer, often to account for a difference in price or as an incentive.
Medicare Part B
The part of Medicare that covers medically necessary services like doctors' visits, outpatient care, and some preventive services and prescription drugs given in a doctor's office or hospital outpatient setting.
ASP+6 payment amount
The amount Medicare typically pays for certain drugs, calculated as the average sales price of the drug plus an additional 6%.
MFP+6 payment amount
The amount calculated as the 'maximum fair price' (the negotiated price) of a selected drug plus an additional 6%.
Coinsurance
ACTION TIMELINE
2 EVENTS
JUL 7, 25
Introduced in House
INTROREFERRAL
JUL 7, 25
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
The portion of a medical cost that a patient is responsible for paying after their deductible has been met, typically expressed as a percentage of the total cost.
Initial price applicability period
The timeframe during which the negotiated maximum fair prices for selected drugs first take effect.
