Experts say a last-minute proposal by President Donald Trump to distribute $200 prescription drug credits to Medicare Part D enrollees on preloaded debit cards faces many unanswered questions and will be difficult to implement, especially in the short time before the Nov. 3 election.
Little is known about the drug credit plan other than what can be gleaned from public statements by the president and an unnamed HHS source cited by the Washington Post. The president announced the plan during a Sept. 24 campaign speech in North Carolina.
"This is just another of the president’s many off-the-cuff promises, one it appears none of his staff knew about before he made it in a campaign speech," says Joe Paduda, principal of Health Strategy Associates.
"This is definitely shameless electoral politics," says Avalere Health founder Dan Mendelson. "Once the $200 is gone, beneficiaries still have to pay out of pocket for expensive medications. I don’t think anybody looks at this and says that this is a solution to the consumer problem [of high drug prices]."
In the absence of a written plan, health care experts have begun to speculate about what legal authority the administration could use to implement the program — which would likely cost about $7 billion — and whether the president has the ability to implement the program at all.
Matt Kazan, a principal at Avalere, says that there seem to be two possible legal avenues for the administration to pay for the debit card program. The first is a demonstration program through the Center for Medicare and Medicaid Innovation (CMMI), and the second via Section 402 of Public Law 92-603, which "grants CMS the authority to waive Medicare payment and benefit statutes to conduct these demonstrations," according to a CMS document.
"Which authority they use probably determines some of the policy specifics," Kazan says. "I think linked to that is a financing question. If you're sending this to all Part D enrollees, the cost of that does become significant."
Leaving all the legal wrangling aside, Raja Sekaran, a partner at Nossaman LLP, says that the short time until the election, and the speed that would be needed to get the drug card program off the ground, will likely doom the proposal.
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