Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals
Section 6219 · Sec. 6219 ·
What this chapter is about
This part rewrites the small copay caps for people with low income. Before 2028 the caps are one dollar and three dollars. From 2028 a generic drug costs nothing, and the other caps rise with prices each year.
The document says “is amended”Who acts: CongressHow: statuteSec. 6219 in the PDF
What the document says
“for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and”
Section 6219 rewrites section 1860D-14(a)(1)(D)(ii) of the Social Security Act. For a plan year before 2028, the copayment may not exceed $1 for a generic drug or a preferred multiple source drug, or the individual's applicable copayment if that is less, and may not exceed $3 for any other drug, or the individual's applicable copayment if that is less.
What the document actually says
“for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and”
That sentence, in plain words
For a generic drug or a preferred drug with more than one maker, the copay is one dollar. If the person's own copay is less, that lower one applies.
What this is about
A copay is what a person pays at the counter. A generic is a drug that copies a brand name one. The cap for other drugs is three dollars.
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The document says “is amended”Who acts: CongressHow: statuteSec. 6219 in the PDF
What the document says
“``(aa) for a generic drug, $0;”
For plan year 2028 and each later plan year, the copayment for a generic drug is $0.
What the document actually says
“``(aa) for a generic drug, $0;”
That sentence, in plain words
For a generic drug, the copay is nothing.
What this is about
This starts with plan year 2028. Before then the cap on a generic is one dollar. After, there is no charge at all.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “is amended”Who acts: CongressHow: statuteSec. 6219 in the PDF
What the document says
“the dollar amount applied under this clause for such a drug for the preceding plan year, increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such preceding year, or, if less, the copayment amount applicable to an individual under clause (iii); and”
For plan year 2028 and each later plan year, the copayment for a preferred multiple source drug, and for a drug in neither of the other two groups, is the prior year's amount increased by the annual percentage rise in the consumer price index for all items, United States city average, as of September of the prior year, or the individual's applicable copayment if that is less.
What the document actually says
“the dollar amount applied under this clause for such a drug for the preceding plan year, increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such preceding year, or, if less, the copayment amount applicable to an individual under clause (iii); and”
That sentence, in plain words
Take last year's amount for that drug. Raise it by how much prices went up. Use the person's own copay if that is less.
What this is about
The price index tracks what things cost across the country. Tying the cap to it means the cap moves each year on its own.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6219 in the PDF
What the document says
“Any amount established under item (bb) or (cc) of subclause (II), that is based on an increase of $1 or $3, that is not a multiple of 5 cents or 10 cents, respectively, shall be rounded to the nearest multiple of 5 cents or 10 cents, respectively.”
The rewritten clause provides that an amount set under item (bb) or (cc), built up from the $1 or the $3 base, is rounded to the nearest five cents or ten cents respectively where it is not already a multiple of that.
What the document actually says
“Any amount established under item (bb) or (cc) of subclause (II), that is based on an increase of $1 or $3, that is not a multiple of 5 cents or 10 cents, respectively, shall be rounded to the nearest multiple of 5 cents or 10 cents, respectively.”
That sentence, in plain words
Round the new amount to the nearest five cents or ten cents. Which one depends on the amount it grew from.
What this is about
A raise tied to prices gives odd figures. Rounding makes them easy to charge. It applies each year the amount goes up.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “is amended”Who acts: CongressHow: statuteSec. 6219 in the PDF
What the document says
“in paragraph (4)(A)(ii), by inserting ``(before 2028)'' after ``a subsequent year''.”
Section 6219 also amends section 1860D-14(a)(4)(A)(ii) of the Social Security Act, inserting the words before 2028 after the words a subsequent year.
What the document actually says
“in paragraph (4)(A)(ii), by inserting ``(before 2028)'' after ``a subsequent year''.”
That sentence, in plain words
After the words a subsequent year, write in two more words: before 2028.
What this is about
The new rule splits the years in two. Words in a nearby part have to say which side they fall on.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The main things the section does: set the copay caps for plan years before 2028, set the zero copay for generic drugs and the yearly increase for other drugs from 2028, set the rounding rule, and add the words before 2028 to a related paragraph.
The inserted text quoted in full. The new subclauses are recorded in summary.
The section amends section 1860D-14(a) of the Social Security Act and points at section 1927(k)(7)(A)(i) of that Act for one term. That Act is not indexed here.
