CMS proposes $2 Drug List Model to reduce out-of-pocket costs for Medicare recipients

Editor's Note

CMS has taken the next steps in making prescription drugs more affordable for Medicare recipients, according to an October 9 report from The US Department of Health and Human Services (HHS).

The proposed Medicare $2 Drug List Model, developed in line with President Biden’s Executive Order 14087, aims to provide Medicare Part D beneficiaries with more predictable, lower out-of-pocket costs by capping monthly copayments at $2 for generic drugs used to treat common chronic conditions, such as high blood pressure and high cholesterol.

CMS has released a Request for Information (RFI) to further refine the model, with public feedback encouraged until December 9, 2024. Participation in the model, which could launch as early as January 2027, would be voluntary for Part D plan sponsors. The list would include medications that are not subject to utilization management requirements, ensuring easier access for patients.

The goal of the Innovation Center’s Medicare $2 Drug List Model is to test whether simplified, low-cost access to essential generic drugs can improve medication adherence, enhance health outcomes, and boost patient satisfaction. Regular updates to the list will reflect new generic drugs, changing clinical guidelines, and pricing trends.

HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure both highlighted this as part of broader efforts by the Biden administration to lower healthcare costs for seniors, building on recent initiatives such as insulin price caps and free vaccines.