Trump Admin Says Nothing is Off the Table for Part D, Drug Cost Reform

by Lauren Kelly

Addressing the opioid crisis, improving transparency for Medicare beneficiaries and operationalizing new Medicare Advantage benefit flexibility were all hot topics at AHIP's National Conference on Medicare, held Oct. 15-16 in Washington, D.C. But as the Trump administration continues to ramp up efforts around drug pricing, one area that generated the most debate and uncertainty was the future of the Medicare Part D program.

Panelists during a session on Oct. 15 — the same day that CMS issued a proposed rule to require manufacturers to disclose drug prices in direct-to-consumer television ads — agreed that in considering all the potential changes that could be made in Part D, there’s an overarching concern of whether reducing the burden in one area ends up inflating costs elsewhere.

The way the program is designed now, high-cost enrollees are driving overall Part D spending growth, and some beneficiaries can easily reach the catastrophic phase just by obtaining one high-cost specialty medication, pointed out the panelists. "We need to look deeper now at some of the mechanisms for Part D…and incentivize more management of the benefit," said Larry Kocot, principal and national leader of the Center for Healthcare and Regulatory Insight at KPMG, LLP.

"We need to free up the plans to use the tools better, but work in the beneficiary protections," he continued.

During a separate session on President Trump's "blueprint" to lower drug prices, two HHS advisors said the administration is looking at all its authority — regulatory, statutory, demonstration — to tackle the issue of drug pricing. And Dan Best, senior advisor for drug pricing reform to the HHS secretary, acknowledged the recommendations made by MedPAC, saying the commission has "spoken sensibly on the need to change the program."

The president's goal is "to lower list price for all Americans," stated Best. "Sometimes people get lost in the fact that we're just focused on the programs under our authority, but the reality is the president's been clear that his objective is to develop a system that will [lower] prices for everybody. And in that, we are all aware of how complex the system is."

From RADAR on Medicare Advantage

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