Fairness for Patient Medications Act

The Fairness for Patient Medications Act establishes patient protections for highly rebated drugs by limiting cost-sharing and regulating how rebates are handled for these drugs in group health plans and health insurance coverage. The bill requires the Secretary to annually certify drugs as 'highly rebated' if total rebates and other price reductions across all commercial markets exceed 50 percent of total annual spending on the drug. For plan years starting on or after January 1, 2025, cost-sharing for a 30-day supply of a highly rebated drug cannot exceed one-twelfth of the annual net price paid by the plan or issuer for that drug. If a highly rebated drug was not covered in the previous year and is now covered, the plan or issuer cannot receive price reductions or other remuneration from the manufacturer unless the reduction is passed on to the enrollee at the point of sale, and any other remuneration is a flat fee not based on sales volume. The bill defines 'entity that provides pharmacy benefits management services' as any entity that negotiates prices or manages prescription drug benefits for a plan, including related entities, and defines 'net price' as the final price after all rebates and remuneration from manufacturers. A health plan will not lose its status as a high-deductible health plan (HDHP) for complying with the cost-sharing cap. These requirements are added to the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code, with corresponding clerical amendments.