Economy

Trump targets drug prices for Medicare beneficiaries

Trump targets drug prices for Medicare beneficiaries

The final policies announced today further the Trump Administration's commitment to lowering drug prices.

CMS finalized its 2019 Medicare Advantage rates, raising payments it pays to insurers, and also made changes to a final rule aimed at curbing opioid misuse and abuse by Medicare beneficiaries. Due to CMS's policy change a year ago, Medicare beneficiaries are now benefiting from the discounts that 340B hospitals receive.

However, CMS noted that it "does not have the flexibility" to establish a lower co-pay amount for biosimilars and interchangeable biosimilars for non-LIS enrollees who are in the catastrophic phase of the Medicare Part D benefit, however, and "given the high cost of biological products in general, the non-LIS catastrophic cost sharing will nearly certainly be [5%]".

The administration said it would help fight the devastating opioid epidemic by, among other changes, allowing providers in the Part D prescription drug plan to make beneficiaries who risk addiction use only selected prescribers or pharmacies for their opioid prescriptions. Beneficiaries are saving an estimated $320 million on out-of-pocket payments for these drugs in 2018 alone. In a call with reporters announcing the changes, led by CMS Administrator Seema Verma, the agency said it was changing how it used encounter data (created by healthcare providers during visits with patients) to set risk scores, by boosting the percentage of such data to 25%, up from 15%. CMS is a division of the US Department of Health and Human Services. Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

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CMS was careful to point out that its change of approach only applies to cost sharing, and "This policy does not change or supersede our existing formulary requirements for biosimilar biological products".

Streamline government review and approval of marketing materials Medicare health and drug plan use.

America's Health Insurance Plans praised CMS' announcement and its "willingness to work with stakeholders to find additional ways to simplify and transform the Medicare Advantage and Part D programs".


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