Plan D Premiums Decline

On July 31, 2018, the United States Centers for Medicare & Medicaid Services announced that for the second year in a row, the basic premium for a Medicare Part D prescription drug plan is expected to decline. Basic Part D premiums are expected to go from $33.59 in 2018 to $32.50 in 2019.

For Medicare Part D, patients are able to choose the prescription drug plan that best first their needs, which according to CMS, is a “competitive dynamic” that “sets up clear incentives that drive towards value, as determined by beneficiaries.”

CMS has been working to ensure that Part D plans can leverage all of the tools available to commercial plans and have made changes through the Trump Administration’s Drug Pricing Blueprint.

Changes made from the Blueprint include the following:

  • Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.”
  • Allowing for certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing.
  • Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.
  • Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.

America’s Health Insurance Plans (AHIP) said the announcement reaffirms that the Part D coverage gap or ‘donut hole’ drug discounts save money for patients at a time when prices for branded drugs are out of control and out of reach for many Americans who need them.

“President Trump and 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,” said CMS Administrator Seema Verma. “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.”

All of the 2019 Part D rates, including the Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Part D income-related monthly adjustment amounts, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks, can be found here.

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Written by Thomas Sullivan