Medicare forces insurers to stop steering seniors toward expensive drugs
S. 4323 — Ensuring Access to Lower-Cost Medicines for Seniors Act · Filed by James Lankford (R-OK) · 2 cosponsors · Introduced Apr 16, 2026 · Referred to committee
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What it does
This bill requires Medicare prescription drug plans (Part D) to include all generic drugs and at least one biosimilar that cost less than their brand-name equivalents, and to place them in lower cost-sharing tiers with copayments at least $20 cheaper than brand drugs. Starting in 2028, insurers cannot use prior authorization or step therapy to discourage seniors from choosing these cheaper alternatives.
Why we flagged it
The bill's core function is to mandate formulary inclusion and favorable cost-sharing for generic and biosimilar drugs in Medicare Part D plans, directly addressing senior medication affordability rather than creating new programs or revenue mechanisms.
What the text implies
- Insurers may respond by raising copayments on brand drugs or narrowing formularies in other ways to offset margin pressure, potentially shifting costs to seniors using specialty or brand medications.
- The bill's reliance on 'wholesale acquisition cost' as the pricing benchmark may create gaming opportunities if manufacturers manipulate WAC pricing, and the Secretary's discretion to define cost thresholds introduces regulatory uncertainty.
The full analysis lists 4 implications of this text.
Who stands to gain
generic drug manufacturers; biosimilar manufacturers; seniors (reduced out-of-pocket costs)