US Medicare Insulin Demo Could Expand To Other Drugs
Eighty-eight insurers who offer Medicare Part D plans are interested in the demonstration project, which would limit insulin copays to $35.
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CMMI payment demonstrations are viewed as way of skirting statutory obstacles to experimenting with new approaches to reimbursement and could lead to significant drug pricing reforms if legislative efforts fail. However, HHS is not signaling an intent to pursue transformational new models at this point.
Almost a third of Medicare drug plans are expected to offer the insulin demonstration next year, while almost none have signed up for the payment ‘modernization’ demo, under which plans would be at more risk for spending during the catastrophic phase. The Centers for Medicare and Medicaid Services also announces basic Part D premiums will average $30.50 for 2021.
PhRMA sues to block implementation of the law, saying it could allow states to compel manufacturers to dispense other medications without compensation.