Sponsor
David Schweikert
Representative · R-AZ
Representative · R-AZ
Requires HHS to create AI-enabled adherence guidelines aiming for 90% adherence for all Medicare Part B and Part D drugs and to promote generics/biosimilars where practicable.
The bill aims to improve medication adherence and cut drug spending by promoting generics/biosimilars and AI-driven targeting — benefiting many Medicare patients and public budgets — but raises privacy concerns, risks burdensome enforcement of high adherence targets, could limit access to needed brand drugs, and will require new implementation costs.
Medicare beneficiaries and taxpayers could pay less for medicines because the bill encourages greater use of generics and biosimilars, lowering drug spending.
Medicare beneficiaries with chronic conditions may have fewer treatment failures and hospitalizations because the bill promotes higher medication adherence (targets around 90%) for Part B and D drugs.
Hospitals, health systems, and state programs could run outreach and monitoring more efficiently because the bill permits use of AI/ML to target adherence interventions, reducing staff time and administrative burden.
Medicare beneficiaries face increased privacy risks because AI-driven adherence tools could use or share sensitive medication and health data.
Patients with chronic conditions and their providers may face burdensome monitoring or quasi-prior-authorization requirements because a uniform 90% adherence target could be unrealistic for many therapies.
Medicare beneficiaries who clinically need brand-name therapies could have reduced access if guidance pressures substitution to generics/biosimilars without adequate clinical exceptions.
Based on analysis of 2 sections of legislative text.
Official title: To amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish drug adherence guidelines, and for other purposes.
Introduced February 7, 2025 by David Schweikert · Last progress February 7, 2025
Requires HHS to create drug adherence guidelines aiming for 90% adherence for all Medicare Part B and Part D drugs. The guidelines must use artificial intelligence and machine learning where appropriate and, to the maximum extent practicable, encourage use of generics and biosimilars. Applies to drugs covered under Medicare Part B and Part D and directs the Secretary to develop standards and approaches (including AI/ML tools) to increase patient adherence to prescribed therapies, with an explicit preference for lower-cost therapeutically equivalent products when practicable.