Sponsors (3)
The bill increases access to and lowers out-of-pocket costs for generics and biosimilars for Medicare beneficiaries, but it imposes compliance burdens on plans and risks cost-shifting, premium increases, or limited choices for certain biologics if sufficient low-cost biosimilars are not available.
Medicare Part D enrollees (and taxpayers) will pay lower out-of-pocket costs and the program may face lower overall Part D spending pressure because cheaper generics and biosimilars are placed on preferred tiers, which can slow premium growth and reduce federal subsidy costs.
Medicare beneficiaries with chronic conditions will gain improved access to biosimilars because plans must list at least two lower-cost biosimilars in preferred positions, increasing competition and treatment options.
Medicare beneficiaries will face fewer administrative barriers (for example, less prior authorization or step therapy) for eligible generics and biosimilars, speeding access to needed medicines and reducing treatment delays.
Medicare Part D plan sponsors and other formulary managers will face reduced formulary flexibility and increased administrative complexity to comply with placement and utilization rules.
Medicare beneficiaries and taxpayers could see cost-shifting or higher premiums if plans respond to lost revenue from preferred placement of lower-priced products by raising premiums or shifting costs to other drugs or services.
For some biologic reference drugs, beneficiaries could face limited choices if fewer biosimilars meet the required price threshold and the 'at least two' preferred-biosimilar requirement is hard to satisfy.
Based on analysis of 2 sections of legislative text.
Requires Medicare Part D plans to place certain lower-cost generics and biosimilars in a preferred formulary position and forbids stricter access limits than for reference products.
Introduced March 27, 2026 by Doris Matsui · Last progress March 27, 2026
Requires Medicare Part D prescription drug plans (PDPs) to put certain lower-cost generic drugs and biosimilar biological products into a preferred spot on their formularies and forbids plans from using prior authorization, step therapy, quantity limits, or other restrictions that make those generics or biosimilars harder to get than the higher-cost reference product. The rule applies to plan years beginning on or after January 1, 2027, and uses existing statutory definitions for terms like covered generic, covered biosimilar, and reference product.