Scoop: Medicare pilot aims for $2 generic drugs
Add Axios as your preferred source to
see more of our stories on Google.
Illustration: Aïda Amer/Axios
The Biden administration on Wednesday will release a preliminary list of generic drugs that would be made available to Medicare recipients under a pilot program for no more than $2 out of pocket.
The big picture: The initiative — which covers common drugs for high cholesterol, high blood pressure and other chronic conditions — aims to test whether offering low-cost generics can boost seniors' medication adherence and health outcomes, while giving them more certainty on out-of-pocket costs.
Driving the news: The administration is asking for feedback on its list of 101 generic drugs that could be covered by the pilot, officials told Axios.
- The list covers common prescriptions like penicillin, metformin, lithium and albuterol asthma inhalers. Thirty-five of the drugs treat blood pressure and other cardiovascular conditions.
- Drugs on the list wouldn't be subject to requirements like prior authorization or quantity limits. There still would be safety-related requirements.
- Medicare's Innovation Center assembled the list by looking at the clinical roles of different drugs, their cost to prescription drug plans and how often they're used by Medicare enrollees.
95% of seniors who used their prescription drug coverage in 2023 filled a prescription for a drug on the sample list, per the Centers for Medicare and Medicaid Services.
- The Innovation Center began developing the list following a 2022 executive order from President Biden directing the center to test new ways to lower patients' drug costs.
Reality check: The program won't start until January 2027 at the earliest, CMS said. When it does launch, the $2 generics program will be optional for Medicare prescription drug plans.
- A future administration could decide to change courses or halt the initiative.
- But starting in 2025, all Medicare beneficiaries will have a $2,000 annual cap on their out-of-pocket drug costs.
