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Protecting Medicare from government interference

Gabby Migliara   |     July 21, 2021   |   SHARE THIS

For more than a decade, Medicare Part D has provided seniors and people with disabilities with affordable and comprehensive prescription medicine coverage. Several surveys show that more than 9 in 10 Part D enrollees are satisfied with their coverage, helping tens of millions of patients manage a number of chronic and life-threatening conditions, including diabetes, mental illness, cancer and heart disease.

Seniors and people with disabilities have robust access to medicines in Part D due in large part to a protection known as the “noninterference clause.” This clause prohibits the Secretary of Health and Human Services from interfering in the private negotiations – which already occur in Part D – between pharmaceutical manufacturers and Medicare Part D insurance plans or pharmacy benefit managers (PBMs). Currently, negotiation is entrusted to private health insurance plans that administer the benefit and offer dozens of plan benefit design choices to people with Medicare. These negotiations on average yield larger savings for brand medicines in Part D than the commercial insurance market and allow for robust choice of coverage and access for people on Medicare. Unfortunately, some in Congress want to repeal this important element of Part D. Without this protection, the government could attempt to “negotiate” and directly and negatively impact access to lifesaving medicines for patients.

Independent analysis by the Congressional Budget Office has repeatedly found that repealing the noninterference clause and permitting government “negotiation” in Part D could only save money if we also sacrificed the choice of and access to medicines that people with Medicare have today. In an attempt to save money, the government would likely have to implement formularies that restrict which medicines seniors and people with disabilities can get in part D – interfering with what their doctors may have prescribed.

Consequently, the repeal of this clause moves the United States closer to a single national list of approved medicines for Part D, similar to how some governments in other countries heavily control which medicines are and are not available to their citizens. For example, in countries like France and Canada, people have access to fewer new medicines and wait longer to get the medicines they need. This is a tradeoff Americans do not support.

We recognize the program needs to be modernized and that some seniors and people with disabilities have concerns with high out-of-pocket costs in Part D. We are committed to working with policymakers to strengthen the Part D program and improve affordability for Medicare beneficiaries. But instead of eliminating the key noninterference clause, policymakers need to keep that provision of Medicare Part D that protects access and choice for seniors and people with disabilities. We can still focus on ways to improve the program, like capping out-of-pocket costs and lowering cost sharing overall and making costs more predictable for seniors and people with disabilities.

Sacrificing choice and access to medicines is not the answer. There’s a better way, but government “negotiation” isn’t it. Learn more about how at PhRMA.org/BetterWay.

Gabby Migliara

Gabby Migliara is a senior manager of public affairs at PhRMA focusing on the cost and value of medicines. She previously worked with the U.S. Census Bureau on marketing and communications for the 2020 Census campaign. Outside the office, Gabby enjoys trying new restaurants, hanging with her cat and exploring DC neighborhoods.

Topics: Part D, Medicare, Proactive Agenda

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