S.694 - Preserving Life-saving Access to Specialty Medicines in America Act; PLASMA Act (119th Congress)
Summary
S.694, also known as the PLASMA Act, aims to amend Title XVIII of the Social Security Act to implement a phased-in manufacturer discount program for plasma-derived products under Medicare Part D. The bill intends to ease the financial burden on beneficiaries by gradually reducing the discounted price of these specialty medicines. The phase-in approach varies based on whether the beneficiary has met their annual out-of-pocket threshold for covered Part D drugs.
Expected Effects
The PLASMA Act will likely result in lower out-of-pocket costs for Medicare beneficiaries who require plasma-derived products, particularly in the initial years of the program. This phased approach could help both beneficiaries and manufacturers adjust to the new discount structure. The changes will be implemented starting in 2026, with varying discount percentages through 2032 and beyond.
Potential Benefits
- Reduced out-of-pocket costs for Medicare beneficiaries using plasma-derived products.
- Gradual implementation allows manufacturers to adjust to the discount program.
- Increased access to essential specialty medicines for those with high medical costs.
- Potential for improved health outcomes due to better medication adherence.
- Targeted relief for beneficiaries with and without high out-of-pocket costs.
Most Benefited Areas:
Potential Disadvantages
- The phase-in approach means full discounts are not immediately available.
- The complexity of the discount structure may cause confusion for beneficiaries and providers.
- Potential for increased administrative burden for manufacturers and pharmacies.
- The exclusion of certain drugs dispensed to low-income subsidy (LIS) beneficiaries and specified small manufacturers may limit the scope of the benefits.
- The long-term impact on the pricing and availability of plasma-derived products is uncertain.
Constitutional Alignment
The bill appears to align with the Constitution's general welfare clause, as it aims to improve healthcare access for seniors, a vulnerable population. Specifically, the preamble of the Constitution states the goal to "promote the general Welfare". Article I, Section 8 grants Congress the power to lay and collect taxes and provide for the general welfare of the United States. The PLASMA Act falls under Congress's authority to legislate on matters related to healthcare and social security.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).