Final rebate rule represents right way to change Medicare

Tom Wilbur
Tom Wilbur December 1, 2020

Final rebate rule represents right way to change Medicare.

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As Washington policymakers look to make changes to Medicare and our health care system overall, there are right ways and wrong ways to address the challenges that seniors and patients face. Indeed, as part of the 2020 election, voters made it clear what they want Washington policymakers to focus on: Addressing COVID-19 and concerns around pre-existing conditions and out-of-pocket costs.

In November, the White House announced the release of the final rebate rule, which seeks to ensure beneficiaries fully benefit from the rebates and discounts manufacturers provide to insurers and PBMs in the Medicare Part D program. The final rebate rule represents the right way to change Medicare for the patients who rely on it. Here’s why:

  • It means that the deep discounts biopharmaceutical companies currently negotiate with health plans may finally provide direct savings for seniors at the pharmacy counter. This change is expected to help reduce patients’ out-of-pocket costs, improve the value of Medicare Part D coverage and improve medicine adherence, which may result in better health outcomes.
  • It could save patients hundreds of dollars or more at the pharmacy counter. For example, a senior with hepatitis C is projected to save more than $3,000 a year on their out-of-pocket costs. Those average reductions in cost-sharing far outweigh the modest $3 - $6 per month estimated increase in premiums. For context, Part D premiums have continuously been significantly lower than projections, going back to the launch of the program in 2006. The base monthly premium for Part D plans is estimated to be $30.50 in 2021.
  • It is strongly supported by seniors and voters. Polling shows this to be true when it comes to the initial policy and also when voters are asked to balance potential premium increases and out-of-pocket savings on prescription drugs. This polling aligns with findings from a Kaiser Family Foundation poll

PhRMA remains committed to pursuing policy solutions that improve our health care system and address what Americans need. As we close out 2020, it’s important that policymakers focus on voter priorities and that any changes to Medicare or our health care system should be done the right way – for the benefit of seniors and patients.

Topics: Part D, Medicare, Out-of-Pocket Costs