Mandating Lower-Cost Generics and Biosimilars Inclusion in Medicare Part D.
This Act requires Medicare Part D prescription drug plans to include lower-cost generic drugs and biosimilar products on their formularies if they cover the corresponding higher-cost brand-name drugs. The goal is to reduce out-of-pocket costs for seniors by mandating significantly lower copayments (at least $20 less) for these cheaper alternatives. Furthermore, plans are prohibited from imposing stricter access limits on generics than on brand-name drugs.
Key points
Starting January 1, 2025, Medicare Part D plans must include cheaper generic and biosimilar versions if the brand-name reference drug is covered.
Plans must create a dedicated cost-sharing tier for generics and biosimilars with copayments at least $20 lower than the lowest brand-drug tier.
Access restrictions (like prior authorization or step therapy) cannot be more restrictive for the lower-cost generic/biosimilar than for the original brand drug.
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