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.