For more than a decade, Medicare Part D has successfully provided nearly 42 million seniors affordable access to vital prescription medications. This program is often held up as a model of a successful public-private partnership, consistently arriving under budget while maintaining a high satisfaction rate among enrollees. Despite the program’s many successes, there are always ways to improve.
The Centers for Medicare and Medicaid Services (CMS) recently took their first steps toward enacting new policies that could help seniors save more money at the pharmacy counter. In a recently proposed rule updating the Part D program, CMS included a Request for Information (RFI) on ways to ensure that manufacturer-negotiated discounts and rebates are reflected at the point-of-sale for patients. The core of this idea is simple: accountability and more savings for seniors at the pharmacy.
Since 1991, my organization, RetireSafe has advocated on behalf of older Americans who rely on programs like Medicare for their health and financial well-being. The innovative and competitive structure of the Medicare Part D program maximizes seniors’ access to medications at a good value to taxpayers.
Part D facilitates negotiations between manufacturers, pharmacy benefit managers (PBMs), and insurers to deliver deep discounts to seniors. Where the RFI comes into play is around those discounts. Too often, manufacturer-negotiated discounts do not make it to the seniors they are designed to help, but rather serve to inflate the bottom lines of health insurance companies and pharmacy benefit managers — middlemen.
The RFI from CMS would create more transparency in this process, shedding a light on system actors pocketing these discounts rather than passing them along to patients who need them. By creating greater accountability in the Medicare Part D program, we can better ensure that the discounts aimed at patients are reflected in the price they pay at the pharmacy, potentially saving seniors a significant amount in out-of-pocket expenses.
The benefits brought about through increased accountability and lower out-of-pocket costs are only the beginning. Cheaper prices at the pharmacy typically mean greater adherence to prescription medications. Greater adherence ultimately improves those treatment outcomes, reducing emergency hospitalizations which in turn saves taxpayers’ money and improves the overall health and viability of the Medicare program.
Under the direction of CMS Administrator Seema Verma, we have seen a new willingness to find innovative solutions to improve existing programs and apply fresh thinking to move vital government programs into the 21st century. The inclusion of the RFI in the latest rule on Medicare Part D is a great first step toward improving an already successful program.
By refocusing the program to benefit patients rather industry middlemen, Administrator Verma can help improve patient outcomes and affordability without sacrificing choice.
Accountability is necessary to ensure that government programs are working on behalf of the taxpayers who support them. Implementing CMS’s RFI — moving it from promising concept to tangible policy — is a logical next step for Medicare Part D. Building and improving upon the already successful legacy of the Medicare Part D program is the best way to ensure it continues to benefit generations to come.
Thair Phillips is President of RetireSafe, a grass-roots, non-profit organization that seeks to educate and advocate on behalf of mature Americans on issues including Social Security, Medicare, health, safe retirement and financial well-being.