Pfluger, Davis Introduce Bill to Lower Prescription Drug Costs for Seniors

WASHINGTON, D.C. — Congressmen August Pfluger (TX-11) and Don Davis (NC-01) introduced bipartisan legislation last week to lower out-of-pocket costs for seniors on Medicare.

The Reducing Drug Prices for Seniors Act would limit an individual's coinsurance responsibility for prescription drugs, ensuring that their share of the drug cost is based on the drug’s net or actual price, which is less expensive.

“The healthcare debate in Washington often devolves into partisan bickering that loses sight of the real problem with our healthcare system: skyrocketing costs with declining patient outcomes," Congressman Pfluger said. "While Medicare Part D was created to help make medications more affordable, too many seniors are still forced to make impossible choices between life-saving prescriptions and basic necessities such as groceries – a concern I often hear from seniors in my district. That is why I am proud to lead the bipartisan Reducing Drug Prices for Seniors Act. This common-sense, market-based solution will lower out-of-pocket costs and make prescriptions more affordable by ensuring seniors' coinsurance payments reflect the actual price of drugs rather than the inflated list prices."

“Seniors on Medicare should not have to face undue hardship at the pharmacy counter,” Congressman Davis said. “By making it just a little easier for those on Medicare to purchase their prescription drugs, we are taking one step towards reducing their financial burden and creating a brighter future. After a lifetime of hard work, seniors across eastern North Carolina and America deserve a stable and well-earned retirement.”

Under current law, coinsurance payments, which are out-of-pocket costs based on a percentage of the medical bill that the patient pays after meeting their deductible, are based on the list or wholesale price of prescription drugs. For example, suppose a Medicare plan requires that the patient pays a 50 percent coinsurance rate and their medication’s list price is $100. In that case, they currently pay $50 out-of-pocket at the pharmacy – even if the insurance company only faced a $50 net cost for the medication. 

This bipartisan legislation would make it so that, in the previous example, the senior would only end up with a $25 coinsurance cost. By lowering costs for seniors at the pharmacy counter, this legislation stands to benefit those among the more than 123,000 Medicare beneficiaries residing in Texas's 11th Congressional District.

Senators Rosen (D-NV) and Cornyn (R-TX) previously introduced a Senate version of the bill in May 2024.

Text of the legislation is available here.