The infrastructure bill being worked on in the Senate this week, one of only issues facing Congress where there is general agreement by both political parties, could affect Medicare in a positive way.
According to Bloomberg News, “To offset some of the cost, the lawmakers are considering proposals to raise money from drug corporations and pharmacy benefit managers, which are third-party administrators that help employers and states oversee their pharmacy benefits, according to two health-care lobbyists and a Republican congressional aide familiar with the discussions.”
“Specifically, lawmakers want to demand refunds from drugmakers for some kinds of physician-administered single-use medicines, which the Congressional Budget Office has estimated could lower Medicare spending by $9 billion over a decade,” according to the Bloomberg report.
The infrastructure proposal also includes savings from reducing what Medicare spends on unused drugs that are left over from single-use vials. This may sound like a small matter but drug-makers stand to lose money from it. In 2019, Medicare paid more than $752 million for drugs that were discarded, according to government data.
The legislation could also affect Medicaid. “They also want to bar spread pricing, in which a pharmaceutical benefit manager charges an employer or Medicaid program more for a drug than they reimburse pharmacies for administering it. PBMs say that practice helps them avoid fluctuations in pharmacy costs,” according to that same report.
As you might expect, drug manufacturers and anyone else affected by the changes are all fighting to stop them with tv ads predicting dire consequences if the plan becomes law.