Some proposed Medicare Part D changes stir controversy

The Bipartisan Budget Act (BBA) of 2018, currently being considered by Congress, would make changes to the Affordable Care Act’s (ACA) coverage-gap provisions for Medicare Part D that could reduce costs for patients and insurers.

Beneficiaries were not happy, however, with one piece of the program—the “coverage gap”—and the Affordable Care Act (ACA) included a provision to eliminate this gap, largely at the expense of drug manufacturers, according to the American Action Forum. Now, additional changes have been included in the most recent budget deal, the BBA of 2018.

Included in the ACA was a provision to begin “closing the coverage gap.” Beginning in 2013, drug manufacturers would be required to discount the negotiated price of their drugs by 50% for all beneficiaries in the coverage-gap phase of their insurance. The remaining 50% of the cost would be shared by insurers and beneficiaries, with the insurers’ liability gradually increasing each year from 0% in 2013 until reaching 25% of the negotiated price in 2020.