The PLASMA Act phases in discounts for plasma-derived products under the manufacturer discount program, starting in 2026, with varying percentages based on whether the beneficiary has met their annual out-of-pocket threshold.
Richard Hudson
Representative
NC-9
The PLASMA Act, or the Preserving Life-saving Access to Specialty Medicines in America Act, introduces a phased-in approach for manufacturer discounts on plasma-derived products under Medicare Part D, starting in 2026. The discounted price will be a percentage of the negotiated price, with the percentage varying based on whether the beneficiary has met their annual out-of-pocket threshold. Certain beneficiaries and small manufacturers are exempt from these discount requirements.
PLASMA Act: Phased-In Discounts on Plasma-Derived Drugs Start in 2026, But Not for Everyone
The "Preserving Life-saving Access to Specialty Medicines in America Act," or PLASMA Act, amends the Social Security Act to gradually introduce discounts on plasma-derived drugs for some Medicare Part D beneficiaries. These discounts kick in starting 2026, but they won't apply to everyone, and the initial savings are pretty small. The bill aims to make these specialized medications more affordable, but it's a slow roll-out with some significant exceptions.
Drip, Drip, Discount: How the Phase-In Works
The PLASMA Act sets up a tiered system of discounts that increase over time. It also matters whether you've hit your annual out-of-pocket spending limit for Part D drugs. If you haven't met that threshold, the price you pay (as a percentage of the negotiated price) changes like this:
- 2026: 99% (a 1% discount)
- 2027: 98% (a 2% discount)
- 2028: 95% (a 5% discount)
- 2029: 92% (an 8% discount)
- 2030 and later: 90% (a 10% discount)
If you have met your out-of-pocket threshold, the discounts get a little better, eventually reaching 80% of the negotiated price in 2032 and beyond (SEC. 2).
For example, imagine a nurse who relies on a plasma-derived drug costing $500 a month. In 2026, before hitting their out-of-pocket max, they'd save just $5 under this bill. By 2030, that monthly savings would be $50. It's something, but it's not a huge immediate relief.
Who's Left Out?
Here's the catch: these discounts don't apply if you're receiving low-income subsidies or if the drug comes from what the bill calls "specified small manufacturers" (SEC. 2). The bill doesn't actually define what a "small manufacturer" is, which is a bit of a gray area. This means people who are already struggling the most with drug costs might not see any benefit from this bill.
The Bottom Line
The PLASMA Act is a step toward making plasma-derived drugs more affordable, but it's a very gradual one. The phased-in approach means significant savings are years away, and the exclusion of low-income patients is a significant limitation. While it might help some down the line, it's not a quick fix for high drug costs, especially for those who need it most.