CMS Puts Off Decision on Lowering Drug Prices Patients Pay at the Pharmacy

Agency offers no timeline for addressing PBM-negotiated rebates

The Centers for Medicare and Medicaid Services (CMS) has laid out a bevy of initiatives that officials said would reduce drug prices for patients covered by the Medicare Part D prescription drug program—but they have made no decisions yet on an issue that has confounded lawmakers and patients alike, according to a recent STAT article.

That issue is whether the discounts that pharmacy benefit managers negotiate for drugs—the “rebates” that lawmakers have been raising questions about in recent months—as well as other fees, should go toward lowering the price that a patient pays at the pharmacy.

“While we are not finalizing any policy in this area at this time, we appreciate the detailed submissions from stakeholders, and we are evaluating these comments as we consider future proposals,” said CMS Administrator Seema Verma in a call with reporters. When asked, Verma declined to share a timeline for making a decision on those policies.

It’s unclear whether lowering the amount of money that the patient pays at the pharmacy would actually lower the total amount of health care spending. According to an analysis by CMS that was part of the proposed rule in November, patients would indeed pay less, but the government would pay more.

Verma said that two policies released Monday will directly lower costs for consumers. One change will lower the cost of biosimilar drugs for low-income patients, and another will enable Medicare beneficiaries to get access to new generic drugs more quickly. CMS estimates the biosimilar provision will save $10 million in 2019, and did not specify how much money the other provision will save.

Currently, a CMS official said, Medicare beneficiaries have to wait until the next open enrollment period before newly approved generic drugs would be available with their insurance. Once the change goes into effect, insurance plans can choose to make them available sooner.

These changes will go into effect on January 1, 2019.

Source: STAT; April 2, 2018.