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119-s-4323119th CongressWALLET

Ensuring Access to Lower-Cost Medicines for Seniors Act

Sponsored By: Senator Lankford, James [R-OK]

Introduced

Summary

Require Medicare Part D plans to include lower-cost generics and biosimilars. This bill would require prescription drug plan sponsors and Medicare Advantage prescription drug plans offering Part D to add generics and at least one biosimilar when the referenced brand is on the formulary, and to create dedicated lower-cost tiers for those products.

Show full summary
  • Families and seniors: Would get broader access to generics and biosimilars and lower out-of-pocket costs after the deductible. Changes apply to plan years beginning on or after Jan 1, 2028.
  • Plan sponsors and MA-PD plans: Would have to include any Part D generic whose wholesale acquisition cost (WAC) is lower than the reference drug and at least one lower-WAC biosimilar, follow uniform rules the Secretary sets, and make timely (including quarterly) coverage determinations.
  • Cost-sharing and benefit design: If a plan uses tiers it must create at least one tier only for generics and biosimilars with copays at least $20 lower than the lowest branded tier or coinsurance at least $20 lower, and specialty tiers must include a parallel generic/biosimilar option with coinsurance at least 5 percentage points lower.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Lower-cost drug tiers for Medicare

If enacted, and starting with plan years on or after January 1, 2028, Medicare Part D plans that use tiers would have to keep at least one tier containing only generics and biosimilars. That tier's copay would have to be at least $20 lower than the plan's lowest branded-tier copay (or the dollar-equivalent $20 lower than expected branded coinsurance), and not below $0. If a plan has a specialty tier, it would have to add a specialty generics/biosimilars tier with coinsurance at least 5 percentage points lower than other specialty tiers. Plans would have to include lower‑WAC generics and at least one lower‑WAC biosimilar for a reference product when available, follow uniform quarterly WAC checks and prompt formulary updates, and not apply stricter prior authorization or step therapy to required generics/biosimilars. The cost-sharing protections apply after the Part D deductible, and plans generally could not put a deductible on generics or biosimilars unless the same or higher deductible applies to all covered Part D drugs.

Definitions and legal cleanups

If enacted, and starting with plan years on or after January 1, 2028, the bill would add clear definitions for Part D terms. It would say what counts as a Part D generic drug, a biosimilar, a reference drug or biological product, and what wholesale acquisition cost means for these rules. It would also add cross-references in Part D law so coverage and cost-sharing rules line up with the new tiering requirements.

Sponsors & CoSponsors

Sponsor

Lankford, James [R-OK]

OK • R

Cosponsors

  • Sen. Hassan, Margaret Wood [D-NH]

    NH • D

    Sponsored 4/16/2026

  • Sen. Bennet, Michael F. [D-CO]

    CO • D

    Sponsored 8/6/2026

Roll Call Votes

No roll call votes available for this bill.

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