HR-5372 : Still Just a Bill

The "Expanding Seniors' Access to Lower Cost Medicines Act of 2023" (H.R. 5372) aims to lower prescription drug costs for seniors by amending Title XVIII of the Social Security Act.

• Purpose: The bill facilitates mid-year formulary changes by Part D prescription drug plans to favor biosimilar drugs over their reference biological products.
• Mechanism:
  • Starting in 2025, Part D sponsors can change the formulary status of a reference biological product (the original brand-name drug) if they add a biosimilar version of that drug to the formulary.
  • The biosimilar must be placed at the same or a higher preferred status, or in the same or lower cost-sharing tier, as the original reference product.
  • PDP sponsors must request approval from the Secretary, and the change can be implemented if approved or if no decision is provided within 30 days.
• Impact: This change would allow Part D plans to encourage the use of lower-cost biosimilars, potentially reducing out-of-pocket expenses for seniors.