News & Views: 7/20 - 7/26

July 27, 2021

President Biden continues to call on Congress to pass Medicare negotiation to lower drug costs.

In a recent speech alongside former Virginia Governor McAuliffe (D), President Biden stated that Congress needs to allow the Secretary of HHS to negotiate drug prices directly with manufacturers. He spoke on how American patients are "getting ripped off" by large manufacturers, as the US pays more than any other major country in the world for the same drugs. To read the full transcript, click here.

Senate Republicans and Democrats both want to revoke Trump’s drug rebate rule but have not agreed what the savings should offset.

CBO had previously estimated that the rebate rule would cost the federal government $177 billion over a decade. Republicans have indicated wanting to use the savings from delaying the rule to pay for the infrastructure packages rather than pursuing unpaid federal taxes, as was their previous plan. However, Democrats plan to use all of the nearly $180 billion in savings to pay for the upcoming budget reconciliation bill. Senate Finance Chair Ron Wyden (D-OR) has said that the rebate rule savings will be included in one of the major bills, but they are still working on final details. To read the entire article, click here.

The Senate is looking to ban spread pricing in Medicaid to pay for infrastructure legislation.

The ban would prevent PBMs from charging a set price to Medicaid patients even if the drug’s cost decreases. Spread pricing bans have been provisions in both Democrat and Republican bills in the past. CBO has previously scored the impact of a spread pricing ban in Medicaid and estimated that it would save nearly $1 billion. It is still unclear if the Senate is looking to ban spread pricing in both Medicaid and private insurance or just the former. To read the full article, click here.

The Center for American Progress (CAP) released a new report on the ways in which drug pricing legislation would lower costs for patients and businesses.

The report highlights estimated savings by stakeholder, including seniors, workers, and employers. The report focuses on Medicare negotiation, but also includes the impact of policies such as inflation rebates and out-of-pocket caps. To read the full report, click here.

Researchers at KFF analyzed Part D, non-LIS, enrollees who have exceeded the catastrophic coverage threshold annually over multiple years.

Researchers found that in 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket costs above the catastrophic threshold of $6,550. Over the entire study period (2010-2019), 3.6 million beneficiaries reached the catastrophic phase in any one year and nearly 2 million beneficiaries had spending over the threshold for at least two years over the decade. To read the full article, click here.

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