By Howard Bedlin | 10.23.2019
This week, two House committees passed legislation that includes
NCOA proposals to make prescription drugs more affordable, particularly for
low-income Medicare beneficiaries and those with high out-of-pocket costs.
Since 2007, NCOA has led advocacy efforts to protect and improve
the Medicare Part D Low-Income Subsidy (LIS or Extra Help). LIS makes Part D
affordable for low-income beneficiaries by helping pay for their prescription
drug premiums, deductibles, and copays.
The House Ways and Means Committee, chaired by Rep. Richard Neal
(D-MA), and the House Energy and Commerce Committee, chaired by Rep. Frank
Pallone (D-NJ), passed legislation that includes eight provisions to improve
the LIS program, six of which are included in the Medicare Part D recommendations NCOA sent to Congress
earlier this year.
The Title IV of the Lower Drug Costs Now Act (H.R. 3) (pages
119-134) would:
1.
Eliminate copayments for generic
drugs for LIS beneficiaries. This
provision is based on H.R. 2757, introduced by Reps. Joe Cunningham (D-SC), Gus
Bilirakis (R-FL), and Dwight Evans (D-PA).
2.
Better educate LIS-eligible
beneficiaries by requiring the Centers for
Medicare and Medicaid Services (CMS) to send them a notice that compares Part D
plan out-of-pocket costs and provides information on opportunities to enroll in
zero premium benchmark plans. This is based on H.R. 4632, introduced by Reps.
Ron Kind (D-WI), Sharice Davids (D-KS), and G.K. Butterfield (D-NC).
3.
Improve the LIS assignment process by replacing the current random assignment of LIS
beneficiaries whose zero premium benchmark plans are no longer available with
an “intelligent assignment” process prioritizing plans with better coverage and
lower costs.
4.
Allow more people to qualify by expanding the income eligibility thresholds for partial
LIS benefits from 150% to 200% of the Federal Poverty Level (FPL) and expanding
the thresholds for full LIS benefits from 135% to 150% of FPL. This provision
is based on H.R. 4620, introduced by Reps. Max Rose (D-NY), Marc Veasey (D-TX),
and Joseph Morelle (D-NY).
5.
Extend eligibility to low-income residents of Puerto Rico and other U.S.
Territories, who are not currently able to receive this vital assistance.
6.
Provide for automatic LIS enrollment by requiring it for all adults who reach age 65 with incomes
below 200% of FPL and who were enrolled in Medicaid. This provision is based on
H.R. 4661, introduced by Reps. Chris Pappas (D-NH) and Paul Tonko (D-NY).
7.
Expand eligibility by eliminating burdensome LIS eligibility asset requirements
and streamlining the enrollment process. This provision is based on H.R. 4628,
introduced by Reps. Mary Gay Scanlon (D-PA), Peter Welch (D-VT), and Brendon
Boyle (D-PA).
8.
Exclude certain retirement accounts from the calculation of assets in determining eligibility.
This provision is based on H.R. 4655, introduced by Reps. Susie Lee (D-NV),
Antonio Delgado (D-NY), and Yvette Clarke (D-NY).
H.R. 3 also includes three other titles with significant Part D
reforms:
·
Title I requires manufacturers of
specific prescription drugs to negotiate with the Secretary of Health and Human
Services for the prices of those drugs or face an excise tax on their sales.
·
Title II establishes a mandatory
rebate for drug manufacturers of certain covered Part B and Part D drugs that
increase in price faster than inflation.
·
Title III includes a $2,000 hard cap
on beneficiaries’ prescription drug out-of-pocket costs. The House proposal
provides significantly better protection than under the bill passed by the
Senate Finance Committee, which included a $3,100 cap. Title III also would
change the structure of the standard benefit design for Medicare Part D.
During committee markup, several other Medicare bills were
considered and passed:
·
Three bills (H.R. 4618, H.R. 4650,
and H.R. 4665) would add dental, hearing, and vision benefits to Medicare Part
B, respectively.
·
The Energy and Commerce Committee
passed H.R. 4671, the Help Seniors Afford Health Care Act, which includes
reforms NCOA has long advocated for that would significantly improve access to
the three low-income assistance Medicare Savings Programs (MSPs) – the
Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income
Beneficiary (SLMB) program, and the Qualified Individual (QI) program. NCOA is
grateful to Reps. Andy Kim (D-NJ), Lisa Blunt Rochester (D-DE), and Dwight
Evans (D-PA) for their leadership in introducing this bill.
Next Steps
Although House floor action is possible next week, some think
November is a more likely timeframe. H.R. 3 passed without Republican support.
Titles I and II are particularly controversial and are likely to struggle to
receive the Republican support needed for Senate passage. Expanding Medicare
dental, hearing, and vision coverage, while laudable and generally supported by
NCOA, would be quite expensive and also could have difficulty getting
bipartisan support.
In the Senate, the Finance Committee passed S. 2543, the
Prescription Drug Pricing Reduction Act with some bipartisan support. The bill
includes a provision similar to Title II of H.R. 3, but Senate floor action has
been held up largely due to the controversial nature of this inflation rebate
section. Unfortunately, the Finance Committee failed to include any of the
eight LIS improvements that are in the House bill.
The path forward on these efforts to make prescription drugs
more affordable will not be easy. Many still hope that a drug bill can be
enacted into law before the December holidays as part of a large omnibus
package that includes budget appropriations bills. However, the controversies
outlined above and the serious tension between House Democrats and President
Trump over potential impeachment proceedings make things difficult to predict.
If your Representative is listed above as advocating on behalf
of low-income Medicare beneficiaries in crafting H.R. 3, please thank them for
their leadership and urge them to continue working to ensure these provisions
are included in whatever final prescription drug bill emerges.
NCOA will continue to work with national, state, and local
partners to pass bipartisan legislation that reduces the cost of prescription
drugs for Medicare beneficiaries in greatest need of help.
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