WASHINGTON – U.S. Senators John Cornyn (R-TX), Jacky Rosen (D-NV), Thom Tillis (R-NC), and Peter Welch (D-VT) today introduced the Share the Savings with Seniors Act, which would lower out-of-pocket prescription drug costs for seniors with chronic health conditions and ensure that the patients most likely to face high out-of-pocket costs directly benefit from the savings that pharmacy benefit managers (PBMs) and plans negotiate:

“PBMs and insurers have long been reaping the cost benefits of negotiating with drug manufacturers on seniors’ behalf, which drives up costs for prescription drugs and sticks the patient with a higher bill,” said Sen. Cornyn. “By requiring rebate savings to pass to Medicare Part D beneficiaries for medicines that treat chronic conditions, this legislation would lower out-of-pocket costs for seniors and alleviate the financial burden they face at the pharmacy counter.”

“For far too long, Nevadans have been forced to pay extremely high prices for prescription drugs, and I believe no one should have to break the bank to pay for life-saving medication,” said Sen. Rosen. “That’s why I’m introducing a bipartisan bill to lower out-of-pocket costs for prescription drugs for Nevada seniors and reduce the amount of money they have to pay at the pharmacy counter. I’ll keep working with anyone – Republican, Democrat, or Independent – to bring down costs for families in our state.” 

“Seniors with chronic conditions oftentimes face unnecessarily high out-of-pocket costs,” said Sen. 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.” 

“Americans pay more for prescription drugs than any other country in the world. All along the pharma supply chain—from manufacturers, to PBMs, to insurers, everyone stands to gain from the high cost of prescription drugs—except the patient. The rising cost of prescription drugs is especially harmful to seniors, forcing them to pay more out of pocket for lifesaving medications,” said Sen. Welch. “I’m proud to join this bipartisan bill to ensure that seniors with chronic medical conditions get the savings negotiated by pharma, PBMs, and insurers.”

Background: 

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.

The legislation is endorsed by Patients for Affordable Drugs and the Texas Healthcare & Bioscience Institute.