The Medicare $2 Drug List Model is a voluntary model under development that would test whether a simplified approach to offering low-cost, clinically important generic drugs can improve medication adherence, lead to better health outcomes, and improve satisfaction with the Part D prescription drug benefit for people with Medicare and prescribers. The model would aim to standardize cost sharing for low-cost generics through a new, easy-to-understand option for people with Medicare Part D enrolled in a participating plan and their health care providers.
The model was initially announced in response to President Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans” within a report from the Secretary of the Department of Health and Human Services.
The Innovation Center is continuing to develop the Medicare $2 Drug List Model with the release of a Request for Information (RFI) (PDF) that seeks input on the sample list of drugs and other features of the model from a variety of interested parties. The deadline to respond to the RFI is December 9, 2024, 11:59 PM PST, and comments can be submitted at https://surveys.cms.gov/jfe/form/SV_40iDHQWMNuVfyGq. The sample $2 Drug List (CSV) for the model is also available in a machine readable format (.csv) with drug names and associated RxCUI information.
Additional Information
- Medicare $2 Drug Model List Request for Information (RFI) (PDF)
- Medicare $2 Drug List Model List RFI Sample Drug List (CSV)
- Press Release: Biden-Harris Administration Takes Next Step on Proposed Model to Lower Prescription Drug Costs for People with Medicare
- Executive Order on Lowering Prescription Drug Costs for Americans
- A Report in Response to the Executive Order on Lowering Prescription Drug Costs for Americans (PDF)
- One-Year Update on the Executive Order to Lower Prescription Drug Costs for Americans
- Request for Information (RFI) Frequently Asked Questions
Why is CMS releasing a Request for Information before announcing the implementation of the proposed Medicare $2 Drug List Model?
The Centers for Medicare & Medicaid Services (CMS) is releasing this Request for Information (RFI) as part of its development process for the proposed Medicare $2 Drug List Model and to gain input from a variety of interested parties on the sample list of drugs and other features of the model. The Innovation Center intends to continue incorporating feedback from interested parties as it continues model development.
How were the specific drugs selected for the sample $2 Drug List?
The medications on the sample $2 Drug List are intended to target common conditions among people with Medicare, such as high cholesterol and high blood pressure, and would not be subject to utilization management requirements (except for safety-related requirements) at any network pharmacy.
The Innovation Center considered several criteria in creating the sample list, including:
- clinical role in therapy based on national treatment and medical society guidelines and public research;
- frequency of use among people with Medicare;
- cost of the drug (for the Part D sponsor) and associated financial impact of inclusion
- rates of inclusion on Part D preferred generic formulary tiers
- presence of prior authorization or step therapy requirements
- inclusion on low-dollar retail and commercial formularies
- inclusion on federal partner formularies (e.g., Veterans Affairs National Formulary)
- number of manufacturers and/or potential for supply interruptions; an
presence on the American Geriatrics Society Beers Criteria®, Drug Enforcement Administration (DEA) scheduled substances, or other safety-related categorizations.
The sample $2 Drug List shared in this RFI represents a starting point for the Innovation Center’s development of the M2DL Model. New generic drug launches, changing clinical indications, and trends in pricing will necessitate updates to the $2 Drug List both prior to launch and at regular intervals during the model.
How is the sample $2 Drug List different than other similar lists that already exist?
Standardized “drug lists” with pre-determined out-of-pocket costs are used by many people with Medicare and providers since large retail pharmacies and grocery chains with pharmacies offer defined lists of prescription generic drugs at low, fixed prices. The Innovation Center’s approach in the proposed Medicare $2 Drug List Model is informed by these commercial options and builds on the concept of standardization but tailors the approach to the needs of people with Medicare Part D and Part D sponsors.
Innovation Center research shows that, despite most Part D sponsors offering a benefit design somewhat similar to the proposed Medicare $2 Drug List Model in 2023, only 20% of people with Part D (about 8 million people) were enrolled in plans that offered a benefit for generics as good as or better than the proposed Medicare $2 Drug List Model. In addition, the specific drugs offered for $2 or less vary by Part D sponsor. We look forward to robust comment on the sample list.