Ensuring Access to Lower-Cost Medicines for Seniors Act

New Medicare drug savings for seniors

If enacted, this bill would require Medicare Part D and Medicare Advantage drug plans to add and favor lower-cost generic drugs and biosimilars. Plans that cover a brand drug would also have to cover any generic whose wholesale acquisition cost (WAC) is lower than the brand's WAC. If a biologic has a biosimilar with a lower WAC, plans would have to include at least one such biosimilar. For tiered plans, the bill would require at least one tier with only generics and biosimilars that charges $0 or at least $20 less than the lowest branded tier (or $20 less than the actuarial average if that branded tier uses coinsurance). Plans with a specialty tier would have to add a specialty tier for high-cost generics/biosimilars with coinsurance at least 5 percentage points lower than other specialty tiers. Sponsors could not apply stricter prior authorization, step therapy, or other access limits to the required generics or biosimilars than to the reference brand. The bill would bar CMS from approving benefit designs that make these generics face a different deductible than other covered Part D drugs unless the deductible applies to all drugs. Most rules would start for plan years beginning January 1, 2028, and CMS would issue uniform rules for WAC comparisons and timing.