H.R. 5197 · Where this bill is now
In committee
Introduced in the House, sent 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, Sep 8, 2025
What this bill does
In plain words · AI-written from the official summaryCaps Medicare drug cost-sharing amounts
This bill changes how much Medicare drug coverage costs you out of pocket. Right now, insurers sometimes charge you more than what they actually pay for a drug after getting rebates from manufacturers. The bill would cap your cost-sharing (the amount you pay) at either the average net price the insurer pays or the cash price without insurance, whichever is lower.
How it affects you
If you're on Medicare and use prescription drugs, this could lower what you pay for medications between your deductible and your annual out-of-pocket limit. The change would apply to both traditional Medicare prescription drug coverage and Medicare Advantage plans. This mainly affects older adults and some people with disabilities who rely on Medicare.
Read the official summary (Introduced in House, Sep 8, 2025)
Protect Beneficiaries from Middlemen Act
This bill limits cost-sharing for covered drugs under the Medicare prescription drug benefit and Medicare Advantage.
Specifically, for costs above the deductible but below the annual out-of-pocket threshold, the bill limits cost-sharing to the average net price of the drug (i.e., the average amount paid less any rebates) or the cash price (i.e., the price charged to an individual without insurance), whichever is lower.
The Government Accountability Office must report on the bill's implementation.
Written by AI (Claude) using only the official summary by the Congressional Research Service, the Library of Congress’s nonpartisan research staff. It can miss nuance, so check the official summary and the bill text for details.
1st SessionH. R. 5197
A BILL
Protect Beneficiaries from Middlemen Act
Sponsor: Rep. Nicole Malliotakis (R-NY-11) · Introduced Sep 8, 2025 · Health · 1 version of the text
Sources: Congress.gov actions and votes · bill text from GovInfo · latest official action Sep 8, 2025: “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.”