Ensuring Access to Lower-Cost Medicines for Seniors Act

Key Points

• Medicare drug plans that use a formulary would be required to include cheaper generic versions of any brand-name drug already on their list, starting January 1, 2028. The same rule applies to biosimilar versions of expensive biological products.
• Plans could not use prior authorization, step therapy, or other access limits to steer patients toward brand-name drugs over required generics or biosimilars. Any limits on the generic must be no stricter than limits on the brand-name version.
• Plans must create at least one cost-sharing tier exclusively for generics and biosimilars, with copays at least $20 lower than the cheapest brand-name tier. This guarantees choosing a generic actually saves patients money at the pharmacy counter.
• For expensive specialty drugs, plans must create a second specialty tier just for generic and biosimilar versions, with coinsurance at least 5 percentage points lower than the branded specialty tier.
• The bill is bipartisan, introduced by Republican Sen. Lankford and Democrat Sen. Hassan. It has been referred to the Senate Finance Committee and would take effect for plan years beginning on or after January 1, 2028.