The first piece of prescription-drug pricing legislation emerged from a unanimous vote on the House Ways & Means Committee in April. That means the Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act is well on its way to passage in Congress, either on its own or in any larger health care bill the House and Senate are likely to pass. All the Democrats and Republicans voted for the bill’s passage, a number of them described it, with some defensiveness, as a “first step” toward reducing drug prices.
H.R. 1035, the Prescription Drug Price Transparency Act, requires greater transparency and accountability from Pharmacy Benefit Managers (PBMs).
H.R. 1034, the Phair Pricing Act, lowers the cost of prescription medication for patients in the Medicare Part D program.
“For too long, we have turned a blind eye as pharmacy middlemen have manipulated drug prices to maximize their profit margin. The Prescription Drug Price Transparency Act will protect patients and pharmacies by increasing transparency over the drug pricing process, providing greater oversight to protect taxpayer dollars, and ensuring patients are able to choose their pharmacy,” said Rep. Collins.
H.R. 1035 increases drug pricing transparency and accountability by accomplishing the following:
- Ensures MAC pricing lists are updated every seven days for Medicare Part D, Medicare Advantage Part-D, and FEHBP.
- Preserves pharmacy access for patients by protecting their ability to choose a pharmacy.
- Requires PBMs disclose sources used in MAC price determinations.
- Provides greater oversight to prevent waste, fraud, and abuse of taxpayer funds in Medicare Part D, Medicare Advantage Part-D, and FEHBP
H.R. 1034 protects patients and provides greater oversight by accomplishing the following:
- Requires all price concessions between a pharmacy and PBM be included at the point of sale to decrease patient’s costs.
- Realigns market incentives to ensure patients have access to and receive the best possible care.
- Directs the Secretary of Health and Human Services to establish a working group of stakeholders to create quality measures based on a pharmacy’s practice.
- Ensures PBMs disclose all fees, price concessions, and programs to CMS.
Prescription drug pricing policy
Public sentiment about prescription drug prices has never been clearer – drug prices are too high. Lawmakers, payers and patients all are concerned about the impact drug price increases have on the health of our country. We are, too.
One key provision requires manufacturers who increase a drug price either by 10% or $10,000 over one year or by 25% or $25,000 over three years to explain the reasons for the increase.
“Under President Trump’s leadership, CMS is delivering on price transparency, because patients have a right to know the cost of their healthcare services before they receive them,” said CMS Administrator Seema Verma.
According to CMS, “The improvements we are making to Medicare Advantage and Medicare Part D deliver on the promises in the President’s blueprint to provide more negotiating tools and more transparency for patients,” said HHS Secretary Alex Azar. “They are significant steps toward a Medicare program, a drug pricing marketplace, and a healthcare system where the patient is at the center and in control.”
CMS is also codifying a policy that enables beneficiaries to select a Medicare Advantage plan that negotiates prices for physician-administered medicines when beneficiaries are first starting on the medicines.
For a fact sheet on the final rule, please visit: https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f
The final rule (CMS-4180-F) can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/05/23/2019-10521/modernizing-part-d-and-medicare-advantage-to-lower-drug-prices-and-reduce-out-of-pocket-expenses.