Bills · HR 5197
IN COMMITTEE· 119TH CONGRESS
House BillHR 5197Health
Protect Beneficiaries from Middlemen Act
INTRO SEP 8· LAST ACTION SEP 8
READING
3MIN
COSPONSORS
0
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
- Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-writtenThis bill matters because it addresses a long-standing concern that patients often pay more for their prescription drugs at the pharmacy counter than what their insurance plan actually pays once manufacturer rebates are factored in. This gap can lead to unexpected and high out-of-pocket costs, especially for people with chronic conditions or those requiring expensive medications.
If this bill becomes law, many Medicare Part D enrollees could see their drug costs decrease, potentially making essential medications more affordable. It aims to increase transparency in drug pricing by linking what patients pay more closely to the true cost of the drug for the insurer. Without this bill, patients would continue to face cost-sharing based on higher list prices, even when their plans receive substantial discounts, contributing to the overall burden of healthcare costs for seniors.
KEY PROVISIONS
3AI-extractedPROVISION 01
Limits the amount Medicare Part D enrollees pay for drugs to the lower of the plan's average net price (after rebates) or the pharmacy's cash price.
This could significantly reduce out-of-pocket drug costs for many seniors and individuals with disabilities.
PROVISION 02
Applies this cost-sharing limitation to low-income individuals receiving assistance through Medicare Part D.
Ensures that vulnerable populations also benefit from more accurate drug pricing and reduced copayments.
PROVISION 03
Requires the Comptroller General to submit a report analyzing compliance, enforcement, and recommendations for improving the new rules.
Provides oversight and aims to ensure the new cost-sharing limits are effectively implemented and understood by the public.
SPONSORSHIP
1 + 0
R· New York
YRS IN OFFICE
5
BILLS LED
55
ACTION TIMELINE
2 EVENTSSEP 8
Introduced in House
SEP 8
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.
BILL INFO
TypeHouse Bill
NumberHR 5197
Congress119th
StatusIn Committee
IntroducedSep 8, 2025
Last actionSep 8, 2025
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IN COMMITTEE· 119TH CONGRESS · WAYS AND MEANS COMMITTEE · INTRODUCED SEP 8, 2025
House BillHR 5197Health
Protect Beneficiaries from Middlemen Act
INTRODUCED SEP 8, 2025· LAST ACTION SEP 8, 2025
PASSAGE CHANCES
—%
READING
3 min
COSPONSORS
0
COMPLEXITY
Moderate
