Medicare Part D premiums down, CMS says, as administration aims to curtail swelling drug costs

DATE: August 2, 2018

Published by McKnight’s

Premiums for nursing home residents’ prescription drug plans have dipped for the second year in a row, in what the administration hopes is a sign that efforts to curb prescription costs might be taking hold.

The Centers for Medicare & Medicaid Services announced Tuesday that it’s projecting the average basic premium for Medicare Part D drug plans in 2019 at about $32.50. That’s a 3.2% dip from the $33.59 spent by seniors the previous year.

Administration officials have made it a key concern to try and drop the cost of drug prices for consumers. They claimed Tuesday that CMS’ recent actions — such as reducing the max amount low-income beneficiaries pay for biosimilars, or allowing certain generics to be substituted onto formularies more quickly — have helped lead to the premium drop.

“President Trump and [Health and Human Services] Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” CMS Administrator Seema Verma said in an announcement. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.”

One of the leading long-term care pharmacy groups ripped Medicare Part D last month, calling it an “oligopoly” that is “corrupting the free market.” The Senior Care Pharmacy Coalition — which says it represents about 75% of independent long-term care pharmacies, serving 750,000 residents — alleged dominant pharmacy benefit managers are one of the key drivers of “skyrocketing drug costs.”

CMS’ recent actions did not address PBMs. However, the House Energy and Commerce Committee recently sent a letter to the Federal Trade Commission, demanding a review of consolidation in the industry. Just three PBMs administer more than 90% of prescriptions doled out to seniors in long-term care facilities. The pharmacy coalition applauded the letter earlier this week.

“We maintain PBM mergers and acquisitions, rapid vertical and horizontal integration, and stubborn adherence to opaque business practices threatens patients in LTC settings, undermines the nation’s commitment to free and fair markets, and ultimately places LTC pharmacies at a competitive disadvantage,” SCPC President and CEO Alan Rosenbloom said in a statement on Monday. “This new letter to the FTC is timely and warranted.”

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