Published: February 2023

Groups support CMS proposal to require a generic drug cost-sharing tier for standardized health plans

In a letter to the U.S. Department of Health and Human Services and the U.S. Centers for Medicare & Medicaid Services, Consumer Action and its allies applauded the agencies’ efforts to standardize health plan choice by requiring generic drugs be placed on “generic” tiers and brand-name drugs on “brand-name” tiers—a step that would help consumers avoid confusion and save money.

The U.S. Centers for Medicare & Medicaid Services (CMS) proposes to make several updates related to standardized health plan options (Medicare, and plans offered on the Affordable Care Act healthcare marketplace and state exchanges). One of the proposals is a requirement that all covered generic drugs be placed on tiers labeled “generic” and brand-name drugs be placed on tiers labeled “brand-name.” In recent years, many formularies have been placing generic drugs on expensive brand-name tiers, thereby causing confusion and imposing unnecessarily higher costs on patients. This simple and practical solution would encourage use of lower-cost generics, reduce patient uncertainty, and lower out-of-pocket costs for lifesaving medicines.

Lead Organization

Association for Accessible Medicines

More Information

Click here to read the coalition letter. 

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