By Thomas Goldsmith
The White House announced Monday reductions in Medicare recipients’ prescription drug costs and additional changes it said would benefit low-income people and others receiving benefits.
In one change, President Donald Trump’s administration said it would reduce the maximum that people with low incomes would pay for the medicines known as biosimilars; those are interchangeable equivalents of biologically produced medication sold under trade names. They’re used as treatment for specific diseases, such as rheumatoid arthritis, some types of blood anemias and a form of vision loss known as macular degeneration.
In addition, the proposed changes would allow new generic equivalents to be added to the Medicare formulary, or list of available drugs, any time during the plan year instead of only during annual changes.
The change would save consumers $10 million annually, CMS said.
“The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said during a teleconference with reporters.
The administration said it would help fight the devastating opioid epidemic by, among other changes, allowing providers in the Part D prescription drug plan to make beneficiaries who risk addiction use only selected prescribers or pharmacies for their opioid prescriptions.
The White House telegraphed some changes more than a month ago, bringing a negative response from some advocates for beneficiaries. Peter Maybarduk, at the nonprofit, nonpartisan Public Citizen think tank in Washington, told the Wall Street Journal in February that the Trump administration could create greater services of beneficiaries by letting the federal government negotiate prices directly with the pharmaceutical industry.
In advance of the announcement, Leigh Purvis, director of Health Services Research at AARP Public Policy Institute, said a cap on spending by recipients Medicare Part B, chiefly doctor’s office services, would serve consumers better than piecemeal changes of the sort announced Monday.
CMS officials said the agency has not reached a decision on whether pharmacies should pass on manufacturer rebates to customers, an issue on which they have been taking stakeholder comment.
In another change, CMS said beneficiaries would save an additional $320 million in their share of drugs through hospitals’ increased negotiating power during 2018, in a policy change that’s being extended to Medicare Advantage plans, which are run by commercial insurers. To compare, the total cost of the Medicare program to the nation is more than $600 billion for the current budget year.
The combined costs of Medicare, mostly for people older than 65, and Medicaid, health insurance for low-income people and those with disabilities, will total $1 trillion, which makes it a likely target for cuts as lawmakers work to accommodate Trump-backed tax-reform legislation passed in December.
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