2020 Outlook: Experts Predict Part D Reform, Minimal Pressure on PBMs

If Congress or the Trump administration are able to enact any type of drug-pricing reform during 2020 — a year sure to be dominated by the upcoming elections — it’s likely to be a redesign of Medicare Part D, industry experts tell AIS Health. That would put some additional financial responsibility on health insurers’ shoulders, but for PBMs, the regulatory overhang appears to have largely abated, experts say.

In the Senate, tweaking the Part D benefit is part of a larger piece of bipartisan legislation (S. 2543), championed by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), which was approved by the Finance Committee in July and was modified in December. From the House, there’s the sweeping legislation (H.R. 3) proffered by Speaker Nancy Pelosi (D-Calif.), which passed in December only to meet a dead end in the Senate. Like the Wyden/Grassley bill, it would implement hard out-of-pocket spending caps for Part D beneficiaries and considerably change how costs are divided up in the catastrophic phase of coverage. In both bills, Medicare would pay less, enrollees would pay nothing, and manufacturers and plan sponsors would pay more in that coverage phase.

© 2024 MMIT
Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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