Medicare Part D and Medicare Advantage drug plans that use formularies would be required, starting January 1, 2028, to include every cheaper generic version of each brand-name drug they cover and at least one cheaper biosimilar for each covered biological product. Plans could not impose tougher prior authorization, step therapy, or other access limits on those generics and biosimilars than on the brand-name versions. Plans using tiered cost-sharing would need at least one tier limited to generics and biosimilars, with copays at least $20 lower than the lowest brand-drug tier. Plans with a specialty tier would also need a second specialty tier for generics and biosimilars with coinsurance at least 5 percentage points lower.
Average Household Impact
- Medicare Part D copays — At least $20 lower on required generic and biosimilar tier
- Generic and biosimilar access — Required on Part D and MA-PD formularies starting 2028
Corporate Benefits
- Brand-name drug preference — Plans barred from giving brand drugs better access than cheaper generics
Congressional Summary
Ensuring Access to Lower-Cost Medicines for Seniors ActThis bill requires prescription drug plans under the Medicare prescription drug benefit to include generic drugs and biosimilars on their formularies.Specifically, the bill requires plans that use formularies to include generic drugs and biosimilars on the formularies and without any requirements (e.g., prior authorization requirements) that are more restrictive as compared to those for brand-name drugs and biologics. Plans that use cost-sharing tiers must also have specific tiers for generic drugs and biosimilars, in accordance with certain limitations.
Details
- Congress
- 119th
- Chamber
- Senate
- Status
- summarized
- Action
- Introduced in Senate
- Action Date
- 2026-04-16
- Date Added
- 2026-05-19
- Source
- Congress.gov →
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