ACP expresses support for proposed Medicare $2 Drug List Model

Author(s):

Austin Littrell

Key Takeaways

The Medicare $2 Drug List Model aims to improve medication adherence and prescriber satisfaction by offering low-cost generic drugs.
ACP supports the model but stresses the importance of monitoring its implementation to prevent negative impacts on prescribers and patients.
The model includes 101 medications across 15 clinical categories and allows for flexibility in updating the drug list.
ACP advocates for timely communication of changes to the drug list to ensure uninterrupted treatment for patients.

The potential CMS model would set a $2 copayment for common generic drugs in an effort to improve medication adherence.

In response to a request for information, the American College of Physicians (ACP) expressed their support for the aim of the Medicare $2 Drug List Model, which is to improve medication adherence and prescriber satisfaction. The model, from the U.S. Centers for Medicare & Medicaid Services (CMS) Innovation Center, would make certain generic prescription drugs available to Medicare beneficiaries for fixed $2 monthly copayments, or no more than $5 for a three-month supply.

Still under development, the model would be offered by Medicare Part D plans that choose to participate. The plan was developed in compliance with former-President Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans.” The model could be implemented as early as January 2027, according to the CMS request for comment.

Dejaih Johnson, ACP manager of regulatory affairs, explained that, although ACP supports the aim of the model, the organization will watch to ensure its seamless implementation, making sure that prescribers and patients are not negatively impacted. “ACP will continue to monitor and engage in the development and implementation stages to ensure that the model empowers prescribers to select the most appropriate and affordable treatment plan for their patients and will not exacerbate administrative burdens, increase beneficiary premiums or restrict patient benefits in other areas.”

Ultimately, the ACP is interested in testing whether a simplified approach to offering clinically important generic drugs at a low-cost would improve medication adherence, health outcomes and prescriber and beneficiary satisfaction with the Medicare Part D prescription drug benefit.

Presently, the proposed model includes a sample list of 101 medications across 15 clinical categories, including 35 blood pressure/cardiovascular drugs, 14 behavioral health drugs and 12 infectious disease drugs.

“[The plan] would build upon the success of existing drug lists used by large retail pharmacies with low, fixed prices,” Johnson explained. “The model was developed by evaluating generic drugs using multiple elements, such as frequency of use, drug cost, therapeutic role based on national treatment and medical society guidelines, prior authorizations/step therapy requirements, inclusion in low-cost formularies by retailers and much more. The information was then reviewed by a technical expert panel of physicians, pharmacists and health policy experts, and their recommendations informed the selection of drugs included in the model.”

Currently, prescription drug costs vary depending on Medicare Part D plan, what stage of cost-sharing a beneficiary is in, whether a beneficiary has a Medicare Advantage plan, how many months of supply are filled at one time and whether coupons are available to lower drug costs, among other factors.

According to Johnson, the model, as proposed, has an inherent, built in flexibility. This means that as new generic drugs enter the market, or as prescribing guidelines or prices undergo sudden changes, drugs could be added or removed from the list over time. “The Innovation Center has sought feedback on how to best develop this update process,” Johnson said.

In response, ACP has encouraged the Innovation Center to ensure that prescribers and patients are “informed timely” of any updates or changes to mitigate interruptions in treatment.

“ACP will continue to work with CMS, the CMS Innovation Center, lawmakers and the administration to ensure patients and physicians can and will benefit from the work to improve prescription drug affordability and access,” Johnson said.