Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year.
“President Trump and Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” said CMS Administrator Seema Verma. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.”
In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value, as determined by beneficiaries. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. Strengthening negotiations is a key pillar of the Administration’s Blueprint to reduce prescription drug costs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations.
Changes that CMS has made to date include:
- Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.”
- Allowing for certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing.
- Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.
- Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.
The upcoming annual Medicare open enrollment period for 2019 begins on October 15, 2018, and ends on December 7, 2018. During this time, Medicare beneficiaries can choose health and drug plans for 2019 by comparing their current coverage and plan quality ratings to other plan offerings, or they can choose to remain in traditional Medicare. The agency will be continuing to improve the website for Medicare plan selection, so beneficiaries can more easily compare options and choose the plan that best meets their needs. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2019 calendar year in mid-to-late September.
To view the 2019 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Part D income-related monthly adjustment amounts, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks, visit: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data.html and select “2019.”