CMS projects decreased Part D premiums in 2019, for second straight year

Drug prices
CMS is estimating that Part D premiums will drop in 2019, for the second straight year. (Getty/Charles Wollertz)

For the second year in a row, CMS projects that Medicare Part D premiums will decrease.

The Centers for Medicare & Medicaid Services estimates that premiums will drop from $33.59 each month to $32.50 in 2019. CMS' Office of the Actuary bases its numbers on bids submitted by drug plans for next year.

CMS Administrator Seema Verma touted to the potential decreases as part of the Trump administration's efforts to reduce drug costs.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

"The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working," Verma said in a statement. "CMS will continue to strengthen the Part D program and bolster plans' negotiating power so they can get the best deal for seniors from prescription drug manufacturers."

RELATED: Medicare Part D spending spikes 77% even with prescriptions down 17%

2019 marks the second straight year that CMS estimates a decrease in premiums following a five-year period of increases between 2013 and 2017.

The premium estimates follow shortly after CMS rolled out several changes to Part D as part of the overall drug price initiative. Some of the agency's updates to the program include:

  • cutting down the maximum price that low-income enrollees can be charged for biosimilars
  • allowing plans to substitute certain generic medications on their formularies more quickly
  • removing a requirement that Part D plans are "meaningfully different" from one another
  • clarifying the "any willing provider" requirement, which could boost the number of pharmacy options for beneficiaries

RELATED: CVS-Aetna, Cigna-Express Scripts mergers would lead to massive Part D consolidation

The Trump administration has called for even bigger changes to Part D as part of its drug pricing blueprint, titled "American Patients First." The blueprint includes provisions that would move certain drugs from Medicare Part B into Part D.

Doing so, according to the administration, would allow plan administrators to better negotiate prices with drugmakers. However, some experts have warned that it could also lead to higher out-of-pocket costs for consumers.

The Community Oncology Alliance, which represents physicians in oncology, also warned that this could increase the leverage of pharmacy benefit managers, which have come under fire for how they use rebates to set prices for consumers.

Medicare open enrollment begins Oct. 15, and CMS said it should release final Part D premium numbers for 2019 in mid-to-late September.

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