Ensuring Access to Lower-Cost Medicines for Seniors Act of 2023
Impact
The bill specifically addresses the formulary requirements imposed on PDP sponsors, stipulating that for plan years commencing on or after January 1, 2024, each formulary must include preferred generic drugs and at least two biosimilar products that are cheaper than their reference counterparts. Additionally, the bill aims to prohibit PDP sponsors from imposing restrictive access limits such as prior authorization on these required medications, thereby facilitating easier access for seniors to needed drugs without unnecessary barriers.
Summary
House Bill 5461, known as the 'Ensuring Access to Lower-Cost Medicines for Seniors Act of 2023', aims to enhance the availability of prescription drugs for seniors under the Medicare Part D program by mandating that sponsors of prescription drug plans (PDPs) include certain generic drugs and biosimilar biological products on their formularies. This requirement is intended to ensure that these lower-cost alternatives are accessible to beneficiaries, thereby potentially reducing their out-of-pocket expenses for medications.
Contention
Despite its potential benefits, HB 5461 may face contention regarding the implementation of these requirements among PDP sponsors. Some industry stakeholders may express concerns about the operational challenges and financial implications of including additional drugs on formularies. Additionally, there could be debates regarding the efficacy and safety of generic drugs and biosimilars compared to their brand-name counterparts, which some may argue could impact the overall quality of care if not addressed properly.
Saving Seniors Money on Prescriptions ActThis bill establishes reporting requirements for pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit and Medicare Advantage, particularly relating to the prices of prescription drugs.Specifically, PBMs must (1) disclose certain information underlying cost performance measurements (e.g., exclusions and terms), and (2) report to prescription drug plan (PDP) sponsors (and to the Centers for Medicare & Medicaid Services upon request) an itemized list of prescription drugs that were dispensed during the previous year and related data about costs, claims, affiliated pharmacies, and other specified information. PDP sponsors may audit PBMs to ensure compliance with this bill's requirements and must annually certify their compliance; PBMs are responsible for any associated civil penalties for violations.In addition, the Government Accountability Office must study federal and state reporting requirements for health plans and PBMs with respect to prescription drug price transparency and recommend ways to streamline these requirements.
To Mandate The Use Of Biosimilar Medicines Under Health Benefit Plans; To Require A Healthcare Provider To Prescribe Biosimilar Medicines; And To Improve Access To Biosimilar Medicines.
Resolve, Directing the Superintendent of Insurance to Collect Data from Health Insurers Related to Prescription Drug Coverage of Generic Drugs and Biosimilars