- For the first time since the program's start in 2006, enrollment in standalone Medicare Part D plans dipped slightly (0.3%) in 2019 compared with the prior year, while enrollment continued to grow in Medicare Advantage drug plans, according to a recent report from the Kaiser Family Foundation.
- There are three dominant firms that rule the Part D market offerings: UnitedHealth Group, Humana and CVS Health. Combined, they covered nearly 60% of the market this year, which includes nearly 45 million people.
- The average premium for standalone Part D plans declined to $40 per month for members, which comes after years of modest increases, according to the report.
There has been a renewed focus on Medicare Part D as concerns grow about seniors' ability to afford their prescriptions. A recent study indicated seniors out-of-pocket spending on drugs continues to climb.
A Congressional Budget Office report from earlier this year found spending on specialty drugs to treat complex and chronic conditions more than tripled from 2010 to 2015.
Wednesday morning, Sen. Chuck Grassley, R-Iowa, said he believes there is support for bipartisan legislation to tackle drug pricing and "schemes" that prevent generics from getting to market faster, according to a conversation he had with Axios.
Grassley is considering legislation that would cap seniors' out-of-pocket spend in Medicare Part D. He's said he wants insurers and drug manufacturers to pay a greater part of the cost once seniors reach what's known as the catastrophic phase of coverage, or when they're on the hook for a percentage of the drug's cost.
"The whole idea is to do away with the incentive to quickly getting people into the catastrophic [phase of coverage]," Grassley said.
CMS is attempting to rein in spending in the Medicare Part D program by stripping away gag clauses that had prevented pharmacists from telling patients when a lower-cost option is available if they pay with cash. CMS is also seeking to require that Part D plans make available EHR tools that allow doctors to see which drug is less expensive under the patient's insurance plan — before the patient ends up at the pharmacy.
The administration is also considering whether to alter the way prescription drugs are paid for by eliminating rebates — in an attempt to curb drug prices — and move those discounts to the point of sale. Pharmacy benefit managers can benefit when list prices, set by drug manufacturers, are higher because they can retain a percentage of the rebate. Many PBMs, however, have said they have started passing 100% of the rebates back to their clients.