Bill · S. 4323· Senate(119-S-4323)
Ensuring Access to Lower-Cost Medicines for Seniors Act
- Introduced
- 4/16/2026
- Last activity
- 4/16/2026 — Read twice and referred to the Committee on Finance.
- Sponsored by
- James Lankford
- Cosponsors
- - 0 - 2
- Introduced
- In Committee
What this bill would do
This bill, titled the "Ensuring Access to Lower-Cost Medicines for Seniors Act," seeks to amend the Social Security Act regarding Medicare drug plans. It requires prescription drug plan sponsors and Medicare Advantage organizations to include certain generic drugs and biosimilar biological products on their formularies if they have a lower wholesale acquisition cost than the reference drug. The legislation also mandates specific cost-sharing tiers to ensure these lower-cost options are affordable for seniors. Additionally, it prohibits certain restrictive access limits on these required drugs. These rules would apply to plan years beginning on or after January 1, 2028.
Yes· 3 of 9
Would people over 65 be better off under this?+9
The bill directly reduces prescription drug costs for seniors on Medicare through mandatory inclusion of lower-cost drugs and lower cost-sharing tiers.
Would retired people be better off under this?+9
The bill lowers medication costs through specific tiering requirements for Medicare drug plans.
Does this lower the price of prescription medicines?+8
The bill requires Medicare plans to include lower-cost generic and biosimilar drugs on their formularies and mandates lower cost-sharing tiers for them.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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Mandatory Inclusion of Lower-Cost Medicines: Plan sponsors must include generic drugs and biosimilar biological products on their formularies if the wholesale acquisition cost is less than the reference drug. This ensures that cheaper alternatives are available to those on Medicare plans (Section 2(a)(i)(I-II)).
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Protections Against Access Restrictions: The bill prohibits plans from imposing limits on access—such as prior authorization, utilization management, or step therapy—that are more restrictive than those applied to the more expensive reference drug (Section s 2(a)(iii)).
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Reduced Out-of-Pocket Costs through Tiering: Plans must include a cost-sharing tier for generics and biosimilars that features either no cost-sharing or a copayment that is at least $20 lower than the lowest branded drug tier (Section 2(a)(K)(i)(II)).
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Lower Specialty Tier Costs: If a plan has a specialty tier, it must include a second specialty tier specifically for generics and biosimilars that has a coinsurance requirement at least 5 percentage points lower than any other specialty tier (Section 2(a)(K)(ii)(I-II)).
Potential Negative Impacts for People
- Deductible Restrictions: The bill limits a plan's ability to approve benefit designs that have a deductible applicable to generic or biosimilar drugs unless that deductible also applies to all other covered drugs on the formulary (Section 2(a)(K)(iv)(II)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Retirees+9Good For Seniors+9Good For Low Income Households+5Good For Middle Class Households+5
- Healthcare
- Reduces Prescription Drug Costs+8Improves Healthcare Access+5Increases Medicare Funding+2
- Social Issues And Justice
- Improves Social Security+4
- Economy And Finance
- Improves Economic Growth+1
- 8/6/2026
- 1 Cosponsor added.
- 4/16/2026
- Read twice and referred to the Committee on Finance.
- 1 Cosponsor added.
- Introduced in Senate
Michael BennetDemocrat · Colorado
Maggie HassanDemocrat · New Hampshire