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.

© 2021 MMIT

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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