Protecting Patient Access to Cancer and Complex Therapies Act

Key Points

• This bill changes how Medicare Part B pays for drugs that have been selected for price negotiation under the Inflation Reduction Act. Instead of cutting the payment rate to doctors and clinics upfront, it keeps the standard payment at ASP+6% (average sales price plus 6%) and requires drug manufacturers to pay the difference back as a rebate.
• Drug manufacturers must pay a quarterly rebate to the government equal to the difference between the standard ASP+6 payment amount and the negotiated maximum fair price (MFP+6), multiplied by the total units dispensed. These rebates go into the Medicare trust fund.
• Patients still get lower out-of-pocket costs. Their coinsurance is calculated based on the lower negotiated price (MFP+6) rather than the higher standard price, so they pay less even though doctors receive the full ASP+6 payment.
• Manufacturers that fail to pay their rebates face civil money penalties, ensuring compliance. The rebate is also excluded from the average sales price calculation so it does not distort future drug pricing benchmarks.
• The bill is designed to protect cancer patients' access to treatments by ensuring doctors and clinics are not financially penalized for administering expensive drugs. Under current law, reduced Medicare payments for negotiated drugs could discourage providers from offering these therapies.