*1860D-2(b)(6) Annual percentage increase - The annual percentage
increase specified in this paragraph for a year is equal to the annual
percentage increase in average per capita aggregate expenditures for
covered part D drugs in the United States for part D eligible
individuals, as determined by the Secretary for the 12-month period
ending in July of the previous year using such methods as the [HHS]
Secretary shall specify.
** 1860D-2(b)(9)(D) APPLICABLE COPAYMENT AMOUNT.—
In this paragraph, the term ‘applicable copayment amount’ means, with
respect to a covered insulin product under a prescription drug plan or
an MA–PD plan dispensed —
(i) during plan years 2023, 2024, and 2025, $35; and
(ii) during plan year 2026 and each subsequent plan year, the lesser of—
(II) an amount equal to 25 percent of the maximum fair price
established for the covered insulin production accordance with part E of
title XI [PRICE NEGOTIATION PROGRAM TO LOWER PRICES FOR CERTAIN
HIGH-PRICED SINGLE SOURCE DRUGS];or
(III) an amount equal to 25 percent of the negotiated price of the
covered insulin product under the prescription drug plan or MA–PD plan.
The New Medicare Drug Bill Is Big, But Seniors Won't See Many Of Its Benefits For Years
Year (CY) 2024 Advance Notice for the Medicare Advantage (MA) and Part D
Prescription Drug Programs -https://www.cms.gov/files/document/2024-advance-notice.pdf
What is RxMOOP? https://q1medicare.com/faq/What-is-the-RxMOOP/732
see: Subtitle B—Prescription Drug Pricing Reform
PART 1—LOWERING PRICES THROUGH DRUG PRICE NEGOTIATION
SEC. 11001. PROVIDING FOR LOWER PRICES FOR CERTAIN HIGH-PRICED SINGLE SOURCE DRUGS.
PART E—PRICE NEGOTIATION PROGRAM TO LOWER PRICES FOR CERTAIN HIGH-PRICED SINGLE SOURCE DRUGS
PART 2 — PRESCRIPTION DRUG INFLATION REBATES
SEC. 11101. MEDICARE PART B REBATE BY MANUFACTURERS
SEC. 11102. MEDICARE PART D REBATE BY MANUFACTURERS
PART 3—PART D IMPROVEMENTS AND MAXIMUM OUT-OF-POCKET CAP FOR MEDICARE BENEFICIARIES
SEC. 11201. MEDICARE PART D BENEFIT REDESIGN
(Social Security Act SEC. 1860D–14C. MANUFACTURER DISCOUNT PROGRAM)
SEC. 11202. MAXIMUM MONTHLY CAP ON COST-SHARING PAYMENTS UNDER PRESCRIPTION DRUG
PLANS AND MA–PD PLANS
SEC. 11401. COVERAGE OF ADULT VACCINES RECOMMENDED BY THE ADVISORY COMMITTEE5
ON IMMUNIZATION PRACTICES UNDER MEDICARE PART D
SEC. 11404. EXPANDING ELIGIBILITY FOR LOW-INCOME SUBSIDIES UNDER PART D OF THE MEDICARE PROGRAM.
SEC. 11406. APPROPRIATE COST-SHARING FOR COVERED INSULIN PRODUCTS UNDER MEDICARE PART D.
SEC. 11407. LIMITATION ON MONTHLY COINSURANCE AND ADJUSTMENTS TO
SUPPLIER PAYMENT UNDER MEDICARE PART B FOR INSULIN FURNISHED THROUGH
DURABLE MEDICAL EQUIPMENT.
The Kaiser Family Foundation (KFF):
"Understanding the Health Provisions in the Senate Reconciliation Legislation"
Urban Institute: "Capping Medicare Beneficiary Part D Spending at
$2,000: Who Would It Help and How Much?"