Medicare Part D Generic Drug Tiering Request for Comment: Implications for Patient Out-of-Pocket Spending and Part D Plan Costs

The Medicare Part D program has offered prescription drug coverage through private plans that actively manage prescription drug benefits through the creation of formulary tiers and cost-sharing. In 2019, CMS proposed restricting plans’ ability to place generic drugs on non-generic tiers. In this analysis, Avalere estimates the implications of CMS’ potential new requirement on beneficiary cost-sharing, plan liabilities and the implications for plans’ share of total costs for beneficiaries.

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Association for Accessible Medicines


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