Medicare Part D plans would be required to cover generics

What does this do?

This bill requires Medicare prescription drug plans to automatically add generic drugs and biosimilar medicines to their covered drug lists when a brand-name version is already covered and the generic or biosimilar costs less. Those generics and biosimilars must be placed on a separate, cheaper cost-sharing tier, with copayments at least $20 lower than the cheapest brand-name tier. Plans also cannot use tools like prior authorization or step therapy in ways that make it harder to get a generic or biosimilar than its brand-name version.

Who does it affect?

Medicare beneficiaries enrolled in Part D prescription drug plans or Medicare Advantage plans with drug coverage would be affected. Insurance companies that run those plans would be required to restructure their drug lists and pricing tiers to follow the new rules.

Why does it matter?

Seniors enrolled in these plans would pay less out of pocket for generic and biosimilar medicines compared to brand-name drugs. Insurance plans would need to update how they organize covered drug lists and cost-sharing tiers starting in 2028.

Where does it stand?