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H.R. 4913

To amend title XVIII of the Social Security Act to require PDP sponsors of a prescription drug plan under part D of the Medicare program that use a formulary to include certain generic drugs and biosimilar biological products on such formulary, and for other purposes.

This bill establishes additional requirements for prescription drug plan (PDP) sponsors that use formularies under the Medicare prescription drug benefit.

Specifically, the bill requires PDP formularies to include covered generic drugs and biosimilars for which the wholesale acquisition cost is less than that of the reference (i.e., brand-name) product. PDP sponsors must also establish specific cost-sharing tiers that apply lower cost-sharing requirements for such covered generic drugs and biosimilars as compared to those for brand-name products.

The bill also prohibits PDP sponsors from instituting certain requirements relating to access to such covered generic drugs and biosimilars that are more restrictive than those for brand-name products (e.g., prior authorization requirements).

Referred to the Subcommittee on Health.

Rep. McKinley, David B. [R-WV-1](R-WV)Sponsor
21 cosponsors12 D9 R
21cosponsors2committees5actions3subjects
  1. Committee

    Referred to the Subcommittee on Health.

    Health Subcommittee
  2. IntroReferralH11100

    Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

    Ways and Means Committee
  3. IntroReferralH11100

    Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

    Energy and Commerce Committee
  4. IntroReferralIntro-H

    Introduced in House

  5. IntroReferral1000

    Introduced in House

To amend title XVIII of the Social Security Act to require PDP sponsors of a prescription … — Informed