Since it was passed in 2006, Medicare Part D has helped Medicare enrollees in a number of critical ways. Part D has consistently provided beneficiaries with positive treatment outcomes, and has been instrumental in providing enrollees with access to essential prescription medications at affordable prices.
The success of Medicare Part D can be partly attributed to the fact Medicare enrollees are free to choose their healthcare provider, which has incentivized pharmaceutical companies and healthcare providers alike to lower the costs of prescription medications.
However, despite the notable successes of Medicare Part D, the rising costs of prescription drugs is still a pressing issue facing enrollees.
Recently, the Centers for Medicare & Medicaid Services (CMS) proposed a rule for the Medicare Part D plan for 2019, which includes a request for information, exploring policies that would be a step toward helping Medicare beneficiaries pay less for their prescription medications, and providing them with increased affordability and access.
Clearly, these proposed changes would deliver major benefits for seniors and the community pharmacists who serve them.
The proposed rule further seeks to explore new ways to ensure that patients benefit more directly from the substantial discounts and rebates that drug manufacturers offer on prescription medicines, and requests information regarding new ways to lower enrollees' costs at the pharmacy counter.
With these manufacturer rebates in mind, Medicare is seeking to reduce costs for beneficiaries, and is soliciting feedback and information on ways to ensure the patient’s out-of-pocket cost at the point-of-sale is more consistent with the drug’s net price. Ultimately, according to CMS, these changes could reduce net beneficiary costs by over $10 billion.
With the RFI CMS is taking steps to ensure more transparency in the rebates and fees collected by Pharmacy Benefit Mangers (PBMs) and health insurers, to ensure that when a Medicare patient picks up their medication at the pharmacy, they too are benefiting from the discounted price.
In addition to exploring new ways to lower prescription drug costs for Medicare enrollees, the proposed Part D rule seeks to increase accessibility to prescription drugs for patients, as well. In the new proposed rule, CMS focused on clarifying and updating the Any Willing Pharmacy (AWP) requirements, which Part D plan sponsors are required to meet in order to participate. The language of some of these requirements often lacks clarity and is notably outdated.
For instance, CMS expresses concerns that the current accreditation requirements can potentially be used to limit participation and the number of pharmacies that distribute specialty prescription drugs, limiting the accessibility of critical medicines to enrollees.
To address this gap, the proposed regulation delineates Part D plans cannot restrict access to certain specialty drugs and also prohibits plan sponsors from limiting pharmacy participation who offer mail delivery.
Though the proposed Medicare Part D rule would not go into effect until 2019, and these affordability questions are contained in an RFI, the rule represents an important step in addressing drug costs, and ultimately toward making sure that essential medicines are more affordable and more accessible for Medicare enrollees.
Doug Schoen is a Democratic pollster, strategist, and best-selling author. His latest book is "Putin on the March: The Russian President's Unchecked Global Advance."
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