Ensuring Access to Lower-Cost Medicines for Seniors Act
This legislation is expected to expand access to lower-cost medications for beneficiaries of Medicare. It addresses rising drug prices by requiring formulary inclusion for generics and biosimilars, thus encouraging their use over more expensive brand-name drugs. The implementation of specific cost-sharing tiers for generic drugs and biosimilars will ensure that they are financially accessible for seniors, promoting better health outcomes by making essential medications more affordable.
Senate Bill 2129, titled the 'Ensuring Access to Lower-Cost Medicines for Seniors Act', aims to amend Title XVIII of the Social Security Act. The primary objective is to mandate that sponsors of prescription drug plans (PDPs) and Medicare Advantage organizations providing MA-PD plans include certain generic drugs and biosimilars in their formularies. The bill stipulates that starting January 1, 2025, if a formulary includes a reference drug, it must also include each generic counterpart if its wholesale acquisition cost is lower. Additionally, there must be at least one biosimilar included for each biological product reference drug, given that it is available at a lower cost.
While proponents argue that the bill is a necessary step toward improving medication affordability for seniors, there are potential concerns regarding pharmaceutical companies' profitability and the market's response. Some stakeholders fear that enforcing such requirements may lead to pushback from drug manufacturers who could restrict access to generics and biosimilars. Additionally, the bill’s stipulations on cost-sharing arrangements might result in complications for plan sponsors in adjusting their formularies to comply with the new requirements.