Morning Briefing
Summaries of health policy coverage from major news organizations
Trump Administration Seeks To Expand Medicare's Negotiating Power In Effort To Curb High Drug Prices
The New York Times: Trump Moves To Lower Medicare Drug Costs By Relaxing Some Patient Protections
The Trump administration proposed on Monday to cut costs for Medicare by reducing the number of prescription drugs that must be made available to people with cancer, AIDS, depression, schizophrenia and certain other conditions. Under the proposal, health insurance plans that provide drug coverage to Medicare beneficiaries would no longer have to cover all of the drugs in six “protected classes.” The change would take effect in 2020 and would lead to lower out-of-pocket costs for Medicare beneficiaries, the administration said. (Pear, 11/26)
The Hill: Trump Administration Looks To Give Private Medicare Plans Negotiating Power On Drugs
Currently, private Medicare health plans are required to cover all or “substantially all” drug in six “protected” classes, such as HIV treatments, antidepressants and cancer drugs, regardless of cost. This gives pharmaceutical companies little incentive to make the drugs affordable, administration officials said. “The lack of any ability for Part D plans to manage drugs in the protected classes has allowed the pharmaceutical industry to command high prices on protected class drugs in Part D, without patients getting a good deal,” Centers for Medicare and Medicaid Services Administrator Seema Verma said in a statement. (Weixel, 11/26)
The Associated Press: Proposed Changes On Medicare Drugs Create Winners And Losers
Verma said the changes, if finalized, would ultimately save money for beneficiaries by sharpening competition among the insurers who deliver Medicare Advantage and prescription coverage. "At the end of the day, the patient remains in the driver's seat," she said. "They decide which plan to pick." (Alonso-Zaldivar, 11/26)
Modern Healthcare: Medicare Considers Passing Pharmacy Rebates To Part D Patients
The CMS in a financial breakdown of the policy said beneficiaries would save between $7 billion and $9.2 billion in cost-sharing over a decade, but that their gains would be offset by higher premiums. It would cost the government between $13.6 billion and $16.6 billion in the same time frame, however, while pharmaceutical companies would save up to $5.8 billion. (Luthi, 11/26)
Stat: HHS Proposes Letting Private Medicare Plans Exclude New Types Of Drugs
It was the first in a series of changes that the Trump administration put forth in a new regulation late on Monday, all of which largely nibble around the edges of the underlying problem of high drug prices. Each of the polices are nonetheless likely to inflame drug companies and allied patient advocates who have said similar policy proposals could limit patient access to medicines. Under current law, private Medicare drug plans are required to cover “all or substantially all” drugs in six classes: 1) antidepressants; 2) antipsychotics; 3) anticonvulsants; 4) immunosuppressants for treatment of transplant rejection; 5) antiretrovirals; and 6) antineoplastics. The original intent was to make sure insurers did not deny vulnerable patients access to potentially life-saving drugs. (Florko, 11/26)
Stat: Trump Team Takes Aim At Pharmacy Fees In Complex New Proposal
The Trump administration wants to tweak Medicare rules to lower patients’ out-of-pocket costs at the pharmacy counter. It sounds simple, but the policy proposal it outlined on Monday is anything but. The actual idea takes aim at the fees some pharmacies pay to some drug makers as part of their contracts with insurance companies or pharmacy benefit managers. It’s separate from the administration’s other hints at changing Medicare “rebates” that flow from drug makers to PBMs to negotiate favorable treatment on a drug formulary. (Florko, 11/26)
