Likelihood of Part D Revamp Increases With COVID Relief Bill

As Congress is likely to look for offsets through future budget reconciliation measures and new reports spotlight the soaring cost of prescription drugs in Medicare Part D, industry experts agree that a legislative overhaul to the Part D program is inevitable. And while there’s been bipartisan support for restructuring the Part D benefit and increasing manufacturer and plan liability, the details of any legislative proposal that advances will be critical for Part D sponsors’ bid planning and coverage decisions.

Three proposals introduced in 2019 sought major changes to Part D and had varying levels of bipartisan support. They are: The Lower Costs, More Cures Act (H.R. 19/S. 3129), introduced by Republican senators including Medicare Advantage champion Mike Crapo (R-Idaho); The Prescription Drug Pricing Reduction Act (PDPRA), introduced by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.); and The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), which passed the House in December 2019. But for reasons that included a divided Congress, heavy pharmaceutical industry lobbying and a priority shift to the COVID-19 pandemic, they did not become a reality.

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