Increased Pharmacy Choice and Drug Access for Medicare Seniors.
This law enhances drug access for Medicare Part D beneficiaries by limiting the ability of insurance plans to restrict where prescriptions can be filled. Starting in 2026, plans can only limit access for highly specialized drugs requiring extraordinary handling, ensuring patients greater freedom to choose any network pharmacy for standard medications. The bill also mandates transparency and reporting requirements for insurance companies regarding these restrictions.
Key points
Starting in 2026, Medicare Part D plans must allow access to most drugs through all network pharmacies, increasing patient choice.
Access restrictions to specific pharmacies are only permitted for "Limited Access Drugs" (those requiring specialized handling or FDA-restricted distribution).
Insurance plans and Pharmacy Benefit Managers (PBMs) must provide written justification and report annually to the government regarding any drug access limitations.
Expired
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