Sponsors (2)
The bill expands timely, lower-cost access to generics and biosimilars for Medicare Part D enrollees—reducing out-of-pocket costs and utilization barriers—while creating administrative burdens and potential plan-level cost responses that could raise premiums or weaken other cost-control tactics.
Medicare Part D enrollees (especially seniors and retirees) will get broader access to lower-cost generic drugs because plans must include generics with lower wholesale acquisition costs (WACs) when a brand product is on the formulary.
Medicare Part D enrollees (including patients with chronic conditions) may pay less out-of-pocket when lower-WAC generics or biosimilars are placed on a low-cost-sharing or specialty biosimilar tier with at least a 5 percentage-point lower coinsurance.
Medicare Part D enrollees (patients with ongoing treatment needs) will face fewer administrative barriers and faster access because plans must apply the same utilization controls (e.g., prior authorization, step therapy) to lower-cost generics and biosimilars as to branded drugs.
Medicare plans and sponsors (and ultimately beneficiaries/taxpayers) may face higher administrative costs to monitor WACs quarterly and to implement required formulary and tiering changes, and plans could respond by raising premiums, administrative fees, or shifting costs to other enrollees.
Medicare beneficiaries and taxpayers could lose indirect cost savings if mandating inclusion of lower-WAC generics reduces plans' bargaining leverage with manufacturers and PBMs, weakening other cost-control strategies.
Medicare beneficiaries and PDP sponsors may face coverage uncertainty when WAC comparisons are ambiguous (for example, if a published WAC is unavailable or product availability is limited), leading to inconsistent determinations about which products must be included.
Based on analysis of 2 sections of legislative text.
Requires Part D formularies (from 2028) to include lower-WAC generics and at least one lower-WAC biosimilar and bars stricter access limits for those products.
Introduced April 16, 2026 by James Lankford · Last progress April 16, 2026
Requires Medicare Part D and Medicare Advantage prescription drug plan formularies (starting for plan years on/after Jan 1, 2028) to list lower-priced Part D generics and, where available, at least one lower-priced Part D biosimilar whenever a reference drug or biological is listed. Plan sponsors must make dated determinations (quarterly during a plan year), follow uniform rules the HHS Secretary issues, implement required formulary changes promptly, and may not apply more restrictive access controls (like prior authorization or step therapy) to the required generics or biosimilars than to the corresponding reference product.