Twenty medication and dozens of insulin merchandise utilized by 8.5 million Medicare beneficiaries could be topic to authorities drug value negotiation if the Construct Again Higher Act (BBBA) had been enacted and totally applied in 2022, in response to a brand new KFF evaluation.
The 20 medication embrace 18 medication accessible to beneficiaries coated underneath Medicare Half D (sometimes medication bought on the pharmacy) and two medication coated underneath Medicare Half B (physician-administered medication). The checklist contains medication used to deal with most cancers, diabetes, bronchial asthma, a number of sclerosis, auto-immune illnesses, glaucoma, and osteoporosis, amongst different illnesses. All 42 insulin merchandise at present coated underneath Half D could be topic to drug value negotiation.
The evaluation, which makes use of Medicare drug spending information for 2019, reveals the potential attain of the BBBA drug value negotiation proposal, underneath the situation that negotiated costs for 20 top-spending Half B and Half D medication, and all insulin merchandise, had been to take impact this yr, in 2022, moderately than in 2028, because the laws requires. Beneath the BBBA, negotiated costs for all insulin merchandise plus as much as 10 Half D medication could be accessible in 2025, whereas negotiated costs for as much as 15 Half D and Half B medication might be accessible in 2027.
The evaluation finds that the supply nonetheless may decrease drug costs for among the top-spending medication coated underneath Medicare Half B and Half D, however lots of the medication with the very best whole Medicare spending could be exempt from negotiation based mostly on the BBBA standards that exempts high-spending medication inside a sure variety of years from FDA approval or if generic equivalents come to market.
The Congressional Price range Workplace has estimated that the present proposal would save the federal authorities about $80 billion over 10 years, in comparison with projected financial savings of $450 billion related to the sooner laws.
The Home has handed the laws and despatched it to the Senate, which has not taken up the invoice. Whereas permitting the federal authorities to barter drug costs is strongly favored by the general public, prospects for the invoice’s passage in Congress stay unclear.