Millions of Medicare Beneficiaries Use
Prescription Drugs That Could Be Subject to Price Negotiation, But Build
Back Better Act Provision Exempts Many Drugs With High Federal Spending
Twenty drugs and dozens
of insulin products used by 8.5 million Medicare beneficiaries would be
subject to government drug price negotiation if the Build Back Better Act
(BBBA) were enacted and fully implemented in 2022, according to a new KFF
analysis.
The 20 drugs include 18
drugs available to beneficiaries covered under Medicare Part D (typically
drugs purchased at the pharmacy) and two drugs covered under Medicare
Part B (physician-administered drugs). The list includes drugs used to
treat cancer, diabetes, asthma, multiple sclerosis, auto-immune diseases,
glaucoma, and osteoporosis, among other ailments. All 42 insulin products
currently covered under Part D would be subject to drug price
negotiation.
The analysis, which uses
Medicare drug spending data for 2019, shows the potential reach of the
BBBA drug price negotiation proposal, under the scenario that negotiated
prices for 20 top-spending Part B and Part D drugs, and all insulin
products, were to take effect this year, in 2022, rather than in 2028, as
the legislation calls for. Under the BBBA, negotiated prices for all
insulin products plus up to 10 Part D drugs would be available in 2025,
while negotiated prices for up to 15 Part D and Part B drugs could be
available in 2027.
The analysis finds that
the provision still could lower drug prices for some of the top-spending
drugs covered under Medicare Part B and Part D, but many of the drugs
with the highest total Medicare spending would be exempt from negotiation
based on the BBBA criteria that exempts high-spending drugs within a
certain number of years from FDA approval or if generic equivalents come
to market.
The Congressional Budget
Office has estimated that the current proposal would save the federal
government about $80 billion over 10 years, compared to projected savings
of $450 billion associated with the earlier legislation.
The House has passed the
legislation and sent it to the Senate, which has not taken up the bill.
While allowing the federal government to negotiate drug prices is
strongly favored by the public, prospects for the bill’s passage in
Congress remain unclear.
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