Tag Archives: Senate Finance Committee

An overview of the Prescription Drug Pricing Reduction Act

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.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

DOL issues 2013 Form M-1 with instructions and self-compliance tool
The U.S. Department of Labor (DOL) has posted on its website the 2013 Form M-1 and filing instructions. The Form M-1 is required to be filed annually with the DOL by certain multiple employer welfare arrangements (MEWAs) providing medical benefits other than exclusively excepted benefits, regardless of whether the MEWA is a group health plan.

Annual Form M-1 filings are due March 1 of the year following the calendar year being reported (with a 60-day extension available on request), but because March 1, 2014, is a Saturday, the filing date for the 2013 Form M-1 will be March 3, 2014.

To access 2013 Form M-1 with instructions, click here.
The self-compliance tool is available here.

Medicare “doc fix” proposal may limit tax exclusion for workplace health coverage
U.S. Senate Finance Committee staff are circulating a list of possible funding offsets for a bill that would reform the Medicare physician payment system (also referred to as the “doc fix”). Although the offsets listed are overwhelmingly limited to Medicare and Medicaid components (e.g., changes relating to high-income beneficiaries, medical education, prescription drugs and manufacturers, or providers and facilities), they also include limiting the tax exclusion for employer-sponsored health insurance. The list indicates that “limiting and rationalizing the tax exclusion for covered insurance” would raise $262 billion over 10 years.

Other offsets on the list with indirect implications for employment-based healthcare coverage include: eliminating exchange subsidies for people with incomes over 300% of the federal poverty guidelines; increasing income-related premiums under Medicare Parts B and D; modifying Part B deductibles for new enrollees; and aligning employer group waiver plan payments with average Medicare Advantage plan bids.

The Medicare physician payment system reform proposal is a high-priority item for Congress; the temporary system currently in operation expires at the end of March 2014. To date, the Senate Finance Committee has marked up a bill (S.1871), as has the House Ways and Means Committee and the House Energy and Commerce Committee (different versions of H.R.2810).

IRS issues report on revealing improper tax credits related to the ACA
The Tax Exempt and Government Entities (TE/GE) Division of the Internal Revenue Service (IRS) issued a report entitle “Potentially improper healthcare credit claim by tax-exempt organizations are generally being identified for review, but improvements are needed” (TIGTA report 2014-13-005), which successfully discovered and blocked improper tax credits related to the Patient Protection and Affordable Care Act (ACA), but found that further scrutiny would improve the scope of coverage.

The TIGTA report found that the IRS had denied more than $1.5 million in tax credits flagged by the TE/GE division’s computer systems. Between January 1, 2012, and July 23, 2012, the TE/GE division initiated pre-refund examinations for 43% of potentially improper credits identified by its computer systems, the report said.

To read the entire report, click here.

IRS updated FAQs for government entities regarding cafeteria plans
The IRS has updated a set of frequently asked questions (FAQs) and answers regarding cafeteria plans of government entities on its website. To access the updated web page, click here.