This week, the Center for Medicare & Medicaid Services (CMS) announced its new Medicare Part D (the prescription drug program for seniors) model based on the Trump administration’s plan to lower costs for Medicare Part D. While the administration claims this is part of an effort to lower skyrocketing out-of-pocket drug prices, this latest proposal would actually put insurance companies in the driver’s seat and limit choices for seniors.
If the administration was serious about lowering seniors’ drug costs, it would leverage the power of government to require drug companies to negotiate directly with Medicare for lower prices, which is currently prohibited under Part D. Instead, this plan would hand over negotiating power to the insurance companies, allowing big insurance to refuse coverage for certain drugs and conditions in the event that pharmaceutical companies refuse to lower prices. Patients would pay the price for this strategy, since some prescription drugs they need might no longer be covered by insurance companies.
If Trump’s policy changes are adopted, Part D plans could remove or refuse to cover drugs with price increases above inflation. It means even if a doctor prescribes a specific medication, patients could be required to spend time experimenting with medications that might be less effective before they would be allowed to get coverage for the more expensive drug. And seniors might be required to get pre-approval for some prescriptions in order to get them covered, adding red tape for patients.
The plan does take some positive steps that will be good for Medicare patients like increasing transparency for consumers and requiring insurance companies to provide doctors with information on the out-of-pocket costs of drugs they are prescribing and less expensive alternatives, but the good news stops there.
President TrumpDonald TrumpTexas announces election audit in four counties after Trump demand Schumer sets Monday showdown on debt ceiling-government funding bill Pennsylvania AG sues to block GOP subpoenas in election probe MORE often touts his business credentials and brags about his negotiating skills, but he’s willfully ignoring his most effective tool in lowering Medicare drug prices: the 44 million Americans on Medicare.
If the GOP truly wants to use power of "the market" to lower the cost of prescription drugs, the most effective policy is to allow direct negotiations and require that those negotiations take place. That’s what Veterans’ Affairs and Medicaid do, and unsurprisingly, both agencies pay a lot less for prescription medications.
We don’t need the Trump administration to come to this conclusion. There are already bills that do this, including Rep. Lloyd DoggettLloyd Alton DoggettLIVE COVERAGE: Tax hikes take center stage in Ways and Means markup American workers need us to get this pandemic under control around the world Biden attempts to turn page on Afghanistan with domestic refocus MORE's (D-Texas) bill, which would both empower the Department of Health and Human Services (HHS) to require these negotiations and leverage the power of government to make the market work better for consumers.
Appointing insurance companies to police pharmaceuticals will only result in some patients losing access to medicines they need because insurance companies will refuse to cover them. The government’s role is to be a watchdog for seniors and people who need these medicines, not to pass the buck to insurers while leaving patients exposed to risk.
Trump and Republicans aren’t “getting tough” on prescription drug companies, they’re lining Big Pharma’s pockets, cutting their corporate taxes by double digits and letting them get away without paying their fair share. This year alone the top 10 PhaRMA companies will receive $6 billion in tax breaks and $76 billion in savings on taxes on money they have offshore.
And now, rather than holding these companies accountable for passing on some of the money they are saving in tax breaks to consumers by forcing real negotiations in Part D, President Trump wants to let them off the hook again. He is essentially telling Americans to put their health care in the hands of the same companies that cheated them for years, while simultaneously weakening patient protections. These companies are already making a killing by using marketing costs as an excuse to jack up prescription prices.
Trump’s “bold” strategy continues to hamstring seniors by denying Medicare the ability to negotiate lower drug prices and allows insurance companies to deny coverage for essential medications. The real winners in this plan are the insurance companies, and we can all agree they don’t need another win at the expense of seniors and Americans who need access to affordable care.
Margarida Jorge is the executive director of Health Care for America Now (HCAN), the national grassroots coalition that from 2008-2013 ran a $60 million five-and-a-half year campaign to pass, protect and promote the Affordable Care Act (ACA).