H.R. 8143: Ensuring Access to Lower-Cost Medicines for Seniors Act of 2026.

This bill, known as the Ensuring Access to Lower-Cost Medicines for Seniors Act of 2026, aims to modify the Medicare prescription drug program (Part D) to enhance the availability of certain lower-cost medications for seniors. Here are the key provisions outlined in the bill:

Inclusion of Certain Medications on Formularies

The bill requires that, starting from January 1, 2027, Prescription Drug Plan (PDP) sponsors must include specific types of medications in a preferred position on their formularies—lists of drugs covered under the Medicaid Part D program. The two primary types of medications that must be included are:

• Generic drugs: Each covered generic drug whose wholesale acquisition cost is lower than that of its reference drug must be included.
• Biosimilar biological products: Plans must include at least two covered biosimilar biological products whose costs are less than that of their reference biological products.

Prohibition on Access Limitations

The bill also prohibits PDP sponsors from imposing more restrictive limitations on access to these included medications than those that apply to the reference drugs. This includes limitations commonly used in prescription management, such as:

• Prior authorization: Requiring approval from the insurance company before a drug can be prescribed.
• Step therapy: Mandating that patients try a less expensive medication before moving on to a more expensive one.

Overall, the aim is to ensure that seniors have better access to affordable medications without unnecessary hurdles imposed by their health plans.

Definitions of Key Terms

The bill includes definitions for several key terms to clarify its provisions:

• Covered biosimilar biological product: A biosimilar drug that is part of the Medicare prescription drug benefit.
• Covered generic drug: A generic drug that has been approved under specific federal regulations.
• Preferred position: A status on the formulary that allows for lower out-of-pocket costs for patients compared to reference drugs.
• Reference drug and biological product: The original brand name drug or biological product that the generic or biosimilar drug is compared to.
• Wholesale acquisition cost: The manufacturer's suggested list price for the drug, used for pricing comparisons.

Impact on Seniors

Essentially, the bill is designed to make it easier and less costly for seniors who utilize Medicare to access essential medications by requiring these lower-cost options be readily available and covered appropriately by their plans.

Relevant Companies

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