Democrats gained power in the House of Representatives in the midterm elections on Tuesday, November 6. Capitol Hill anticipates major changes coming from the House, including whether or not to give Medicare the power to negotiate drug prices. But is it possible? In short, not yet. The Senate and White House would need to be on board to make this happen.
American Patients First
The Trump administration has been attempting to address soaring drug prices for the past two years. Trump promised to allow Medicare to negotiate prices since early in his campaign, but that has yet to happen.
In May, the administration released a blueprint to lower prices call “American Patients First.” The blueprint detailed how some physician-administered drugs would be moved from Part B coverage to Part D coverage in order to allow the free market to drive down prices. However, that may not work. Instead of allowing Medicare to negotiate drug prices, the Trump administration is attempting to work around the system as opposed to fixing the broken system.
Medicare negotiating drug prices
Despite Trump’s promises, it doesn’t appear the administration will allow Medicare to negotiate drug prices anytime in the near future. This is especially true of expensive physician-administered Part B drugs in particular.
For example, many new chemotherapy medications administered by IV are covered by Part B, not Part D. Instead of giving Medicare the authority to negotiate drug prices, the Trump administration’s blueprint suggests shifting coverage for these IV drugs to be covered by Part D instead of Part B. Since Part D is administered by private insurance companies, they would in theory be able to negotiate lower drug prices.
However, not all drugs are covered by a Part D drug plan, including many of these new chemotherapy drugs. Even when they are covered, they are more expensive under Part D as opposed to Part B. Additionally, coverage of these drugs would depend on many factors like drug prices, mix of medications, income level of the patient, and whether the patient has Part D coverage or Original Medicare with Medigap.
The shift could also mean higher out-of-pocket costs for patients, like increased premiums and copays.
Although Congress is aware of the problem of high prescription drug prices, it seems like they have more work to do before the problem is fixed and Medicare enrollees pay a lower price for prescription drugs.