Senate Insulin Bill Focuses On List Prices With Carrot For Manufacturers, Stick For PBMs
US legislation attempts to address manufacturer, pharmacy benefit manager impact on patient costs in addition to health plan benefit designs. Critics suggest it’s too easy on manufacturers but that may help its chances with Republicans.
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Though popular, the proposal to cap insulin copays is a relatively minor part of the drug pricing reform package included in the stalled Build Back Better Act. But it may represent Democrats’ best chance of passing any drug pricing-related legislation while they still hold majorities in Congress.
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.
Rebates would be prohibited and insurance coverage required without restrictions for insulin products with steep price roll-backs under bill from Reps. Diana DeGette, D-CO, and Tom Reed, R-NY.