The Prescription Drug Pricing Reduction Act (PDPRA) of 2019 proposes changes to the Medicare Part D program that could impact all stakeholders beginning as early as 2021. The Senate Finance Committee approved a draft of this Act on July 25, 2019. The key provisions affecting Part D include:
1. Redesigning the Part D benefit, including eliminating the current coverage gap phase, establishing an out-of-pocket maximum for beneficiary cost sharing, and splitting the cost of catastrophic phase claims between plan sponsors, the federal government, and drug manufacturers.
2. Requiring drug manufacturers to pay a rebate directly to the federal government if prices for certain Part D drugs increase faster than inflation.
3. Mandating public disclosure of aggregate rebates, discounts, and other pharmacy benefit manager (PBM) contract provisions.
In this article, Milliman consultants provide an overview of these provisions and the potential effects on Part D stakeholders. The PDPRA also proposes changes to the Medicare Part B and Medicaid programs. However, the authors only focus on the proposed changes relating to Medicare Part D.