Senators Ask CMS to Consider Directing Pharmacy Fees to Medicare Patients

ANCOR is sharing this article by Politico Pro because of the precedent this discussion could set for Medicaid, which funds the majority of supports for people with disabilities in the United States.

As written by Politico Pro:

“Senate Finance Committee leaders are urging CMS to require that health plans share pharmacy fees with Medicare patients at the time they purchase drugs — a move that could save seniors an estimated $7 billion to $9 billion in out-of-pocket costs over a decade.

CMS floated the idea in a November 2018 draft rule, but ultimately decided not to implement the policy in the May final rule. The move would likely benefit pharmacies and drugmakers, while hurting health plans.

The reforms to direct and indirect remuneration in Medicare will “provide needed financial relief to pharmacies and beneficiaries,” Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) wrote to HHS leaders in a letter signed by a bipartisan group of 23 committee members. The 45,000 percent increase in these pharmacy fees from 2010 to 2017 is “untenable” for pharmacies and leads to higher prices for patients, they said.

The senators acknowledged that CMS has estimated that the proposal could increase government spending, because health plans might increase premiums due to the change. However, they said Medicare would reap savings from improved medication adherence and health outcomes the policy change would spur because of the reduction in seniors’ drug costs.

The change in pharmacy fee allocation is a more modest approach than the now-abandoned Trump administration idea to require that plans pass through drug manufacture rebates at the point of sale.”