WASHINGTON, D.C. — The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has taken a decisive step towards reducing prescription drug costs with the release of a Request for Information (RFI). This initiative is aimed at refining the proposed Medicare $2 Drug List Model, developed under President Biden’s Executive Order 14087, which seeks to lower prescription drug costs for Americans.
The Medicare $2 Drug List Model proposes that beneficiaries enrolled in a participating Medicare Part D plan will have access to a selection of essential generic drugs for a set copayment of no more than $2 per month. This program primarily targets medications for prevalent conditions such as high cholesterol and high blood pressure, aiming to provide beneficiaries with predictable out-of-pocket expenses.
HHS Secretary Xavier Becerra emphasized the importance of this model, noting its potential to make vital medications affordable for seniors and individuals with disabilities. “Reliably low copayments for essential generic drugs make it more likely that seniors and people with disabilities can afford the drugs they need to stay healthy,” Becerra stated. This initiative builds on previous efforts by the Biden administration to cap insulin costs and make vaccines freely available to Medicare recipients, further cementing Medicare’s negotiating power to reduce prescription drug prices.
CMS Administrator Chiquita Brooks-LaSure highlighted the agency’s commitment to utilizing all available strategies to ensure affordable access to prescriptions for Medicare beneficiaries. The Medicare $2 Drug List Model is designed to enhance the accessibility and affordability of generic drugs under Medicare Part D, and CMS is actively seeking public input to refine the model.
The Innovation Center within CMS is responsible for developing this model, which aims to test the impact of simplified, low-cost access to essential generic drugs on medication adherence, health outcomes, and Part D satisfaction among Medicare beneficiaries and healthcare providers. The list of generics considered for inclusion would avoid utilization management protocols, barring essential safety requirements, across network pharmacies. Participation in the model is voluntary for Part D sponsors, with an anticipated launch as early as January 2027.
Liz Fowler, CMS Deputy Administrator and Director of the Innovation Center, described the $2 Drug List as an initial framework for medications to be included in the model, with plans for regular updates based on new drug launches and evolving clinical guidelines. The process to develop the sample drug list was data-driven and involved consultation with external experts, including physicians and pharmacists, to ensure its clinical relevance and comprehensiveness.
Drawing inspiration from existing retail pharmacy models that provide low-cost generics, the Innovation Center aims to tailor this approach to meet the specific needs of Medicare beneficiaries. The goal is to maintain a robust list of Part D drugs that align with common prescriptions, ensuring most patients will find an affordable treatment option on the $2 Drug List.
As the Medicare $2 Drug List Model progresses, CMS is seeking ongoing feedback through the RFI to refine the model and incorporate stakeholder input. This initiative marks a significant advancement in efforts to enhance the affordability and accessibility of essential medications for Medicare beneficiaries across the nation.
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