On March 1, President Joe Biden was trying to push for some version of the Build Back Better (BBB) Act to be passed during the State of the Union address, according to Forbes.
The President specifically discussed capping the out-of-pocket insulin costs for diabetic patients. He also mentioned allowing Medicare to negotiate the prices of certain prescription drugs.
One of the provisions of the BBB Act is the Affordable Insulin Now Act which would cap monthly out-of-pocket insulin costs for all diabetic patients at $35.
However, Biden did not mention a possible redesign of the Medicare Part D (outpatient) drug benefit – the least controversial part of BBB. He failed to mention it probably because it was too twisted to include in an address to the nation. Yet, an overhaul of Medicare Part D could have a major impact on drug prices.
Currently. Medicare Part D plans have weak incentives to control prescription drug costs for high-cost enrollees. The BBB Act, which is now stalled, aims to redesign the Medicare Part D drug benefit.
Redesigning it could help reduce the amount of spending that beneficiaries are responsible for during the initial phase of the benefit from 25% to 20%.
It would require pharma companies to provide a discount of 7% on brand-name drugs in the initial phase of the benefit. It would also require Part D plans or Pharmacy Benefit Managers (PBMs) to include concessions and fees they negotiate with a pharmacy in the price beneficiaries pay for drugs at the pharmacy counter, according to Forbes.
The redesign of the Medical Part D benefit would lead to larger increases in mandatory manufacturer discounts, especially branded drugs that belong to the six protected classes, according to an analysis by Avalere Health, a leading healthcare consulting and advisory firm.
For now, the BBB proposal is not completely dead. Some provisions of it may be resurrected. At the same time, some pieces of normal legislation could be proposed in Congress. The act has bipartisan support so it is likely that Medicare Part D redesigning would constitute an integral component of any passable legislation.