Congress Could Pass Medicare Part D Reform Even Amid COVID-19 Outbreak

by Leslie Small

With the federal government consumed by responding to the COVID-19 outbreak, the possibility of Congress passing drug-pricing legislation might seem dim. But analysts say it's very possible that something like an overhaul of the Medicare Part D benefit could still make its way into legislation that federal lawmakers pass in the coming weeks or months to address the ongoing public health crisis.

Congress' latest coronavirus-related stimulus package, which is worth more than $2 trillion, also contains provisions that would extend some Medicare and public health funding. That's important for those watching drug-price reform because, when Congress failed to include measures addressing surprise medical billing or drug pricing in the budget bill it passed in December, many expected those issues to be addressed in legislation passed by a May 22 deadline to renew certain health care "extenders."

However, just because the latest stimulus bill wiped out the May deadline, it doesn't preclude the possibility of Congress passing other health care legislation in the near future that could be a vehicle for drug-pricing measures, Matt Kazan, a principal at Avalere Health, tells AIS Health.

In fact, because so many Americans will be struggling economically in the coming months, the calls for the Trump administration and lawmakers to increase drug affordability will only get "louder and louder," Andrew Baum, the head of global health care research at Citi, said during a March 24 call with analysts about the effect of the coronavirus on the health care sector.

And it appears that the drug-pricing measure with the greatest chance of passing is an overhaul of the Medicare Part D benefit, Miryam Frieder, a practice director at Avalere Health, said during a recent webinar hosted by the consultancy. It's the one provision in drug-pricing legislation Congress has considered in the past year that both political parties largely agree on, she pointed out.

Michael Schneider, a principal at Avalere, added that Part D plans need to be prepared for the benefit to get a makeover.

"This is just going to mean that plans are going to have to look at their membership and some other factors and start to decide how they're going to overcome that additional liability without premiums going through the roof," Schneider said.

From RADAR on Drug Benefits