Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) Friday released an updated version of their bipartisan Prescription Drug Pricing Reduction Act of 2019 and announced that an agreement was reached to fund critical, expiring health care programs.
“This updated legislation turns a very good bill into a great bill that will help Americans afford the prescription drugs they need,” Grassley said. “Seniors and Americans with disabilities will see even lower out-of-pocket costs. This bipartisan legislation also helps pay for critical health programs nationwide. And it achieves all of this without charging the taxpayer a dime more. Big Pharma will also finally be held accountable to taxpayers who subsidize their billions of dollars in annual profits. Congress has the opportunity to deliver a real, concrete win for the American people. Now it just needs to show courage and finally act. Members of Congress who fail to meet this test will have to face their constituents and won’t have a believable explanation for why they chose not to act. It should get a vote soon.”
“This agreement delivers even more savings to Americans, cracks down on the drug industry’s tricks, and secures key health programs for years to come,” Wyden said. “I’m proud of the bipartisan work that’s been accomplished so far, in particular for Chairman Grassley’s leadership and our commitment to capping out-of-pocket costs for seniors and requiring drug companies to pay back Medicare if they increase prices faster than inflation. It’s time to put Americans over Pharma profits and pass this bill.”
Legislative text can be found HERE.
BACKGROUND:
- The agreement makes improvements that the chairman, ranking member and other committee members discussed when the committee reported the bipartisan bill in July.
- The changes build off of the $25 billion reduction in beneficiary Part D cost-sharing (over a 10-year period) generated by the committee-reported bill by further reducing beneficiary costs on out-of-pocket spending.
- The Part D redesign section of the bill is improved by changes that:
- Reduce the amount of spending that beneficiaries are responsible for during the initial phase of the benefit from 25 percent to 20 percent, lowering costs for beneficiaries who have expenses above their deductible.
- Require drug companies to provide a new discount of 7 percent on brand-name drugs in the initial phase of the benefit and reset the brand catastrophic discount to 14 percent, maintaining the overall liability for drug companies from the original PDPRA while spreading it across the broader benefit avoids a disproportionate impact on small, innovative companies.
- The changes also include the addition of two new sections that:
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- Direct insurers to offer a cap on the amount of out-pocket-costs that a beneficiary has to pay in any one month; spreading high out-of-pocket costs over multiple months protects against the burden of a significant one-time expense.
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- Require Part D plans and their Pharmacy Benefit Managers (PBMs) to include concessions and fees they negotiate with a pharmacy in the price beneficiaries pay at the pharmacy counter, reducing out-of-pocket expenses and prohibiting retrospective recoupment of payments to pharmacies as to provide more financial predictability.
- These changes further improve the ability of beneficiaries to afford their medications while protecting the investment in development of new treatments for conditions such as diabetes, cancer and Alzheimer’s disease.
Details regarding the health extender provisions can be found HERE.
