Ensuring Access to Lower-Cost Medicines for Seniors Act
Key claim: The Ensuring Access to Lower-Cost Medicines for Seniors Act would require Medicare prescription drug plans to include generic drugs and biosimilars on formularies without more restrictive utilization-management requirements than brand-name products and to maintain specific cost-sharing tiers for them.
Abstract
(S4323 · 119th Congress) Ensuring Access to Lower-Cost Medicines for Seniors Act This bill requires prescription drug plans under the Medicare prescription drug benefit to include generic drugs and biosimilars on their formularies. Specifically, the bill requires plans that use formularies to include generic drugs and biosimilars on the formularies and without any requirements (e.g., prior authorization requirements) that are more restrictive as compared to those for brand-name drugs and biologics. Plans that use cost-sharing tiers must also have specific tiers for generic drugs and biosimilars, in accordance with certain limitations. Latest action (2026-04-16): Read twice and referred to the Committee on Finance.
Why this matters
The bill would directly change what Medicare Part D beneficiaries pay and how easily they can access generic drugs and biosimilars, by preventing plan sponsors from using prior authorization, step therapy, or unfavorable tier placement to steer patients toward brand-name products. For plans and PBMs, it constrains formulary design tools historically used to negotiate rebates on brand drugs. Its impact on out-of-pocket costs would depend on which products currently face brand-favoring utilization management in Part D formularies.