Medicare Part D’s ‘Catastrophic Cliff’ Slows Eliquis, Trulicity Sales In Third Quarter
Pfizer, BMS and Lilly see sales impacted by Part D changes that leave some beneficiaries in the coverage gap longer this year, extending manufacturer discount obligations.
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With no legislative remedy in sight, the Medicare Part D out-of-pocket payment threshold will increase by $1,250 in 2020, causing many beneficiaries to linger longer in the coverage gap, where manufacturers provide 70% discounts on branded drugs.
Company seeks to avoid Medicaid “best price” implications by administering the program through an insurance policy with AIG, which is handling claims for refunds and processing payments.
Pilot program offers Part D beneficiaries an alternative to manufacturer assistance in the form of copay coupons, which are prohibited in government-sponsored health plans. New program also available to commercial insurance and cash-paying patients.