The PLASMA Act phases in manufacturer discounts for plasma-derived products under Medicare Part D, starting in 2026, with varying percentages based on beneficiary out-of-pocket expenses.
Thom Tillis
Senator
NC
The PLASMA Act delays the full implementation of manufacturer discounts for plasma-derived products under Medicare Part D, phasing in the discounts from 2026 to 2032, depending on whether the beneficiary has met their out-of-pocket threshold. This phased approach aims to ensure continued access to these critical medicines, which are derived from human blood or plasma. The discounts do not apply to low-income subsidy recipients or drugs from small manufacturers.
PLASMA Act Phases In Medicare Discounts for Blood-Derived Drugs Starting 2026: Small Manufacturers and Low-Income Recipients Exempt
The "Preserving Life-saving Access to Specialty Medicines in America Act," or PLASMA Act, tweaks how Medicare Part D handles discounts for plasma-derived products – basically, medications made from human blood or plasma. Starting in 2026, the bill phases in mandatory discounts from manufacturers for these drugs, but it's not a one-size-fits-all deal. (SEC. 2)
Slow Roll to Savings
The percentage of the discount depends on whether a patient has hit their yearly out-of-pocket drug spending limit. Think of it like this: if you're someone who needs these specialized meds regularly, you'll likely hit that limit. If you don't, the discount is a bit smaller. Either way, the discount increases over time. For example, in 2026, the discount is 1% off the negotiated price, whether or not you've met your out-of-pocket threshold. By 2030, it's 10% off. But for those who have hit their out-of-pocket max, the discount jumps to 20% off by 2032. (SEC. 2)
Who's In, Who's Out?
This phase-in doesn't apply to everyone. If you're on low-income subsidies, this change doesn't affect your costs. Also, drugs from certain "specified small manufacturers" are exempt. So, a small biotech firm making a plasma-derived drug might not have to play by these same discount rules. (SEC. 2)
Real-World Ripple Effects
Let's say you're a retiree with a chronic condition requiring a plasma-derived drug that costs $1,000 a month. Under this bill, in 2026, you'd initially save $10 a month. By 2030, that’s $100. If you typically hit your out-of-pocket max, by 2032, you're saving $200 monthly. It's a gradual shift, not an overnight price slash. The law, as amended, is Section 1860D-14C(g)(4) of the Social Security Act.
This is all about balancing costs. The government's trying to make these often-expensive drugs more affordable for Medicare patients, but also give drug companies time to adjust. One potential challenge? Drug makers could raise initial prices to offset the later discounts. The bill aims to improve the predictability of medication costs, but it's worth watching how it plays out in practice.