|
 Right now, drugs given by infusion or injection in outpatient
settings like doctors' offices are covered by Medicare Part B, which
is part of the original Medicare program. In a push to curb health
spending, the Trump administration has proposed moving coverage for
many of these physician-administered medicines to standalone drug
plans known as Medicare Part D, which typically contract with
pharmacies to fill prescriptions for consumers.
"Currently, Medicare Part B does not actively negotiate drug prices.
The idea underlying this policy proposal is that plans in Part D
have negotiating power that will help drive total spending down
compared to Part B," study coauthor Dr. Nina Jain of Brigham and
Women's Hospital in Boston told Reuters Health by email.
To see how the proposal might impact total drug spending and
patients' out-of-pocket costs, researchers examined data on the 75
brand-name prescription drugs associated with the highest Part B
spending among fee-for-service Medicare members in 2016.
These 75 drugs accounted for $19.8 billion - or $21.6 billion at
2018 prices, researchers report in JAMA Internal Medicine. Under the
proposed policy change, the researchers estimate, total Part D
spending would be $17.6 billion to $20.1 billion, after rebates to
insurers and pharmacy benefit managers.
This means moving coverage from Part B to Part D might correspond
with roughly a 7 to 18 percent decrease in drug spending, the
analysis found.
Savings may be limited, however, by several brand-name drugs that
are in a "protected" class that must be covered by insurance. This
includes certain physician-administered antipsychotics,
anticonvulsants, antidepressants and antiretrovirals.
"About 40 percent of the drugs we studied were in a protected
class," Jain said. "Part D plans must cover most drugs in protected
classes, limiting plans' ability to negotiate lower prices for these
drugs."
[to top of second column] |
Overall, shifting coverage from Part B to Part D would decrease
median out-of-pocket costs for patients by $860.
But patients who purchase Medigap plans to cover co-payments and
deductibles not covered by Part B might find their out-of-pocket
costs rise.
For people with Medigap insurance, estimated out-of-pocket costs
would rise by a median of $1460 for those with Part D coverage and
by a median of $1952 for those without Part D coverage.
One limitation of the study is that it didn't account for how the
proposed changes might impact insurance premiums or medication use,
the study authors note. It also only examined fee-for-service
Medicare, and didn't look at what would happen with people in other
types of plans, such as Medicare HMOs.
Patients are impacted by rising drug costs through the cost of
premiums they pay for part B, and in some instances by other fees
like deductibles and co-payments, noted Dr. Francis Crosson,
coauthor of an accompanying editorial and a member of the Medicare
Payment Advisory Commission in Washington, D.C. Rising drug costs
can also influence out-of-pocket costs for patients with Plan D
coverage.
"Policymakers interested in reducing what Medicare and beneficiaries
pay for drugs will need to decide whether to make adjustments in how
Parts B and D currently work or to substantially change either or
both payment processes," Crosson said by email.
SOURCE: http://bit.ly/2Fq2gxL JAMA Internal Medicine, online January
14, 2019.
[© 2019 Thomson Reuters. All rights
reserved.] Copyright 2019 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
