To amend title XVIII of the Social Security Act to require PDP sponsors of a prescription drug plan under part D of the Medicare program that use a formulary to include certain generic drugs and biosimilar biological products on such formulary, and for other purposes.

Plain-English Summary

This bill would change the rules for Medicare Part D prescription drug plans — the part of Medicare that helps seniors and people with disabilities pay for their medications. Specifically, it would require insurance companies that run these drug plans to include certain generic drugs and biosimilar products on their approved drug lists, known as "formularies." A formulary is essentially a list of medications that a plan will cover; if a drug isn't on that list, patients usually have to pay full price or go through a lengthy appeals process to get coverage.

Generic drugs are lower-cost versions of brand-name medications that contain the same active ingredients, while biosimilar products are similar lower-cost alternatives to expensive biologic drugs (complex medicines made from living cells). Right now, Medicare drug plan sponsors have significant flexibility in deciding which drugs to include on their formularies, which can sometimes mean cheaper generic or biosimilar options are left off the list in favor of pricier brand-name drugs.

If passed, this bill would most directly affect the roughly 50 million Americans enrolled in Medicare Part D plans, potentially making it easier and cheaper for them to access lower-cost medication alternatives. It could also affect the insurance companies and pharmacy benefit managers that administer these drug plans, as they would have less flexibility in designing their formularies. The bill has been referred to two House committees — Energy and Commerce, and Ways and Means — for review, and no further action has been taken yet.