AAM applauds CMS proposed rule requiring generic drugs to be covered on tiers

In the Health and Human Services Notice of Benefit and Payment Parameters for 2024 proposed rule released on Dec. 12, the Centers for Medicare & Medicaid Services proposed standards for issuers and marketplaces, as well as requirements for agents, brokers, web-brokers and assisters that help consumers with enrollment through Marketplaces that use the federal platform.

These changes would further the Biden-Harris Administration’s goals of advancing health equity by addressing the health disparities that underlie our health system. The proposals build on the Affordable Care Act’s promise to expand access to quality, affordable health coverage and care by increasing access to health care services, simplifying choice and improving the plan selection process, making it easier to enroll in coverage, strengthening markets, and bolstering program integrity.

[Read more: AAM reacts to Avalere study on generic drug costs]

CMS proposes to make several minor updates with respect to standardized plan options. Specifically, a proposal that issuers of standardized plan options must:

• Place all covered generic drugs in the standardized plan options’ generic drug cost-sharing tier, or the specialty drug tier if there is an appropriate and nondiscriminatory basis; and 
• Place brand name drugs in either the standardized plan options’ preferred brand or non-preferred brand tiers, or specialty drug tier if there is an appropriate and non-discriminatory basis.

The organization proposes this specification to reduce the risk of discriminatory benefit designs, minimize barriers to access for prescription drugs, and reduce the risk of consumer confusion for those enrolled in these plans.

The Association for Accessible Medicines commended CMS for its proposal requiring generic drugs to be covered on generic tiers.

[Read more: Avalere analysis examines Medicare Part D’s plan tier placement of generics]

"This common-sense approach will result in meaningful savings for America’s patients," said David Gaugh, interim CEO of AAM. "As CMS notes, ‘it is reasonable to assume that consumers expect that only generic drugs are covered at the cost-sharing amount in the generic drug cost-sharing tier.’ Not only is this a reasonable assumption, but it is an important step to ensuring that patients are not forced to overpay for low-cost generics. AAM looks forward to working with the Agency to finalize this proposal.”