October 4, 2024

CBO Says Costs of Medicare Part D Changes Are Ballooning

The Congressional Budget Office (CBO) has updated its projections on the cost of the redesign of the Medicare Part D program passed by Democrats in the Inflation Reduction Act (IRA). I have argued in several blogs (see these: https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ and https://www.healthcarelabyrinth.com/part-d-restructuring-in-inflation-reduction-act-could-have-huge-implications-on-standalone-part-d-program/ ) that Democrats did not think through the impact on both premiums over time as well as the stability of both Medicare Advantage (MA) and the standalone Part D (PDP) program. The generous out-of-pocket reductions would be paid by higher premiums and benefit changes since the government did not fund the policy changes. The Centers for Medicare and Medicaid Services (CMS) created an emergency demonstration program to stabilize premiums in 2025. But that only lasts for three years. I also think the program is extra-legal.

Now, the CBO is saying that the original estimates of the Part D changes have increased dramatically. It will cost $10 billion to $20 billion more next year than initially projected. In addition, the demonstration will cost another $5 billion in 2025.

(Article may require a subscription.)

#ira #partd #pdp #medicareadvantage #cms

https://www.statnews.com/2024/10/03/drug-pricing-law-higher-cost-cbo/

Exchange Rule Drops For 2026

The Biden administration is busy crafting rules early so they can be enacted for 2026 before Biden leaves office in January. The first major accelerated rule to drop is the one on the Exchanges. There are a series of major changes, including to broker oversight and the federal risk adjustment program. Brokers and risk adjustment are also major themes in Medicare Advantage (MA) and I expect them to be in the accelerated 2026 MA and Part D rule to come soon.

Additional article: https://www.modernhealthcare.com/policy/cms-benefits-payments-policies-aca-2026

(Some articles may require a subscription.)

#exchanges #aca #obamacare #riskadjustment #marketing #cms

https://www.fiercehealthcare.com/payers/cms-proposes-risk-adjustment-changes-fraud-crackdown-and-more

Lilly Says Compounding Pharmacies Must Stop Tirzepatide GLP-1 Fulfillment

Eli Lilly is arguing that compounding pharmacies must stop fulfilling tirzepatide GLP-1s now that the Food and Drug Administration (FDA) shortage is over. Compounders have been fulfilling non-injectable forms of various GLP-1s due to the shortages that exist for these drugs. This is allowed under the law. Compounders are arguing that shortages in the supply chain do still exist for Lilly GLP-1 products and they should not be stopped right away. They want the FDA to approve an off-ramp, where fulfillment can continue for 60 days to allow transitions by consumers. Shortages exist for semaglutide GLP-1s. Some compounders are arguing that they still have the right to fulfill even outside of a shortage to meet individualized dosing for clinical needs. Compound versions of GLP-1s are a fifth to a third of the cost of popular brand injectables.

In other news, studies suggest patients must stay on GLP-1s or they will regain some weight.

Additional article: https://www.medpagetoday.com/special-reports/exclusives/112138

(Some articles may require a subscription.)

#glp1s #weightlossdrugs #branddrugmakers #drugpricing

https://insidehealthpolicy.com/daily-news/eli-lilly-calls-stop-glp-1-copies-compounders-seek-fda-flexibility

Medicare Physician Rate Cut Could Have Major Fallout

Doctors are fighting to survive in private practice and may turn away more patients because of ongoing Medicare physician pay cuts. Medicare physician rates could be cut 2.8% after a 1.69% cut in 2024. Physicians have not had a permanent fix for decades now. For 2025, the cut has not yet been partially or fully reversed due to the budget impasse. A temporary funding bill was passed and expires on December 20. I will have a special doc pay blog on Monday.

#cms #medicare #physicians #providers #rates

https://www.medpagetoday.com/practicemanagement/reimbursement/112273

KFF Survey Covers Public Views On Prescription Drugs

Good Kaiser Family Foundation (KFF) survey and analysis on the public’s views on prescription drugs. A few findings:

  • About eight in ten across parties say drug maker profits are a major contributor to drug costs.
  • A majority is worried about affordability of drugs.
  • A quarter say they have difficulty in affording drugs.
  • A third have not taken their drugs as prescribed due to costs.
  • Almost three-quarters want government regulation to reduce drug prices, this includes more than two-thirds of Republicans.
  • 85% support the Medicare drug price negotiation law.

#drugpricing #ira #branddrugmakers #election2024

https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/

— Marc S. Ryan

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