Medicare Part D premiums on two year decline with projected drop in 2019, CMS says

According to the Centers for Medicare & Medicaid Services, the average basic premium for a Medicare Part D prescription drug plan is slated to drop again in 2019. Basic Part D premiums are forecasted to fall from $33.59 this year to $32.50 next year, the agency said.

“President Trump and Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” said CMS Administrator Seema Verma. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.”

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries.

In April, CMS announced that it had finalized several other changes to Medicare Part D policy as well. Those changes included: reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars”; allowing certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing; boosting competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available; and increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have, CMS said.

America’s Health Insurance Plans said the announcement reaffirms that the Part D coverage gap or ‘donut hole’ drug discounts save money for patients at a time when prices for branded drugs are out of control and out of reach for many Americans who need them.

When Congress required manufacturers to give bigger discounts on branded drugs for seniors in the 2018 Bipartisan Budget Act, it lowered costs for both seniors and hardworking taxpayers, AHIP said.

“The changes made in the BBA lower premiums for Medicare beneficiaries, increase manufacturer discounts for brand name drugs in the donut hole, and extend discounts to ‘biosimilar’ versions of high priced biotech drugs,” AHIP said. “Despite aggressive efforts by the pharmaceutical industry to reverse these changes, we urge Congress to continue to resist efforts to undo these new provisions and protect seniors’ affordable access to the care they need.”

Medicare open enrollment for 2019 starts October 15 and ends December 7, during which time beneficiaries can choose health and drug plans for 2019 by comparing their current coverage and plan quality ratings to other plan offerings, or they can choose to remain in traditional Medicare. Premiums and costs for Medicare health and drug plans for the 2019 calendar year will be released in mid-to-late September, CMS said.

The problem of rising Medicare Part D spending was highlighted in a June report by the Office of the Inspector General that showed both Part D spending and out-of-pocket costs had spiked from 2011 to 2015.

The total reimbursement for all Part D brand-name drugs  swelled by 77 percent from 2011 to 2015 even though there was a 17-percent drop in prescriptions for those drugs. Even after taking into account manufacturer rebates, reimbursement for Part D brand-name drugs still increased by 62 percent during that time period, the report said. There are also more beneficiaries shouldering $2,000 in out-of-pocket costs nearly doubled as well.

By: Beth Jones Sanborn, Managing Editor, Healthcare Finance

Posted on: August 1st, 2018 at 8:07pm by howardhwang. Filed under: Customer News Letter, Medicare Insurance
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