CMS Unveils Sample $2 Generic Drug List for Medicare Part D Enrollees-2027

[Duaine]

But experts are skeptical the list would have much impact.​

The Centers for Medicare & Medicaid Services (CMS) on Wednesday issued a request for information on a proposed model program that would lower prices to $2 per month for certain generic drugs purchased through Medicare Part D drug plans, but experts expressed concerns about the potential uptake and usefulness of such a program.

The model is designed to provide individuals more certainty about the out-of-pocket costs for these generic Part D drugs for common conditions, such as high cholesterol and high blood pressure, CMS said in a press releaseopens in a new tab or window.

"We want generic drugs for common chronic conditions to be affordable for people on Medicare. Reliably low copayments for essential generic drugs make it more likely that seniors and people with disabilities can afford the drugs they need to stay healthy," HHS Secretary Xavier Becerra said in the release.

[EXTERNAL LINK] - CMS Unveils Sample $2 Generic Drug List for Medicare Part D Enrollees

 

[medicare_bid]

But experts are skeptical the list would have much impact.​

The Centers for Medicare & Medicaid Services (CMS) on Wednesday issued a request for information on a proposed model program that would lower prices to $2 per month for certain generic drugs purchased through Medicare Part D drug plans, but experts expressed concerns about the potential uptake and usefulness of such a program.

The model is designed to provide individuals more certainty about the out-of-pocket costs for these generic Part D drugs for common conditions, such as high cholesterol and high blood pressure, CMS said in a press releaseopens in a new tab or window.

"We want generic drugs for common chronic conditions to be affordable for people on Medicare. Reliably low copayments for essential generic drugs make it more likely that seniors and people with disabilities can afford the drugs they need to stay healthy," HHS Secretary Xavier Becerra said in the release.

[EXTERNAL LINK] - CMS Unveils Sample $2 Generic Drug List for Medicare Part D Enrollees

Given that most Medicare plans pay around $0 for the drugs likely to be listed, sounds dumb.

 

[Duaine]

CMS:

 

[just-a-client]

This was baffling - I never paid more than $0 for this kind of drug. Then it occurred to me maybe it's intended to also cover non preferred pharmacies, and maybe even out of network. I guess some people have trouble accessing preferred pharmacies?

Also, where plans apply deductible to all tiers, sometimes these generics can cost more than $2.

 

[InsuranceGuy29]

Given that most Medicare plans pay around $0 for the drugs likely to be listed, sounds dumb.

Just another "brilliant" idea from the Biden/Kamaliar puppets at CMS who don't know their @$$e$ from a hole in the ground, yet these are the people making decisions about our livelihoods. The plans already cover tier 1 and 2 generics unbelievably well. Most are free.

 

[just-a-client]

I guess I'm blocked by a lot of people - which is fair since I'm not an agent.

For the record, I have used a combo BP drug that plans cover in tier 1 ($0 for me) or sometimes tier 2 ($5 for me), where with one of my plans, as listed on the monthly EOB, the retail cost is $39, which the insurer is covering entirely or mostly. That would affect people subject to deductible in Tier 1 or 2.

The $2 drug list includes lots of similar combination drugs but not, unfortunately, that one, but this is just an early proposed list.

The list also includes a drug which at least one of the 2025 plans I've looked at prices at $6.95.

The current $2 drug list is a CSV but opens readably in my browser, so you can check through it - maybe some interesting drugs are included.

https://www.cms.gov/priorities/innovation/files/m2dl-model-rfi-appendix

 

[MedicareWAA]

I guess I'm blocked by a lot of people - which is fair since I'm not an agent.

For the record, I have used a combo BP drug that plans cover in tier 1 ($0 for me) or sometimes tier 2 ($5 for me), where with one of my plans, as listed on the monthly EOB, the retail cost is $39, which the insurer is covering entirely or mostly. That would affect people subject to deductible in Tier 1 or 2.

The $2 drug list includes lots of similar combination drugs but not, unfortunately, that one, but this is just an early proposed list.

The list also includes a drug which at least one of the 2025 plans I've looked at prices at $6.95.

The current $2 drug list is a CSV but opens readably in my browser, so you can check through it - maybe some interesting drugs are included.

https://www.cms.gov/priorities/innovation/files/m2dl-model-rfi-appendix

That’s the list price. It’s not necessarily what your insurance plan actually pays, net.

 

[just-a-client]

By list price - well, ignore the "cash price" printed on pharmacy receipts which is entirely bogus. (Uninsured people who didn't know about GoodRx might have to pay that price, but those prices are highway robbery.)

What Medicare usually calls "retail price" is also, and better, called the negotiated price, the price that shows up on the monthly Part D EOB. For brand drugs, insurers typically get rebates, though the way that works is changing (rebates should now be included at the point of sale), but there's no manufacturer rebates for generics. There are also pharmacy concessions that also are changing - in the past they would be charged back to pharmacies months later, but now they too are supposed to show up right away.

Regardless of all of that, the price shown on the EOB is what the plan does pay for the drugs at least initially, and the entire point is that, if the drug is subject to the deductible, that is absolutely what the insured person would have to pay out of pocket at the pharmacy counter.

Here is a screencap of a section of a claim from 2023. This was a Tier 1 generic, and I paid $0. The price of the drug that the Caremark PBM arranged with CVS pharmacy for this plan was an outrageous $279.50, which is what Wellcare paid CVS, and is what I would have had to pay had this Tier been subject to the deductible! Ouch. Even if you don't believe Wellcare ultimately paid that price to CVS, you can believe that's the price I'd have paid if it was subject to the deductible.


So that is pretty black & white. This drug is not included in the $2 drug list, but the very similar lisinopril/HCTZ combination drug is.

That was an EOB from 2023. In 2024, Wellcare switched PBMs and now uses Express Scripts, and the negotiated price for this drug is now a reasonable $10.03.