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MedPAC Explores Drug Coverage Plan Problems as Part D Stand-Alone Plan Access Declines

  • Nov 26
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    Nov 26, 2024

    The Medicare Payment Advisory Commission (MedPAC) is analyzing the differences between Medicare outpatient drug coverage in Medicare Advantage prescription drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDP), ideally to help preserve stand-alone plans as an ongoing option for beneficiaries.

    Concerns about declines in the number and attractiveness of PDPs in recent years relative to MA-PD plans, which appears to be exacerbated by the Part D redesign established by the Inflation Reduction Act, is driving the work. MedPAC discussed the issue at its Nov. 7 public meeting.

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    • Cathy Kelly

    Cathy is a senior writer with Pink Sheet and has covered U.S. regulation and reimbursement policy for the biopharma industry since 2004, starting with the establishment of the Medicare Part D program. Since then, she has written extensively about developments in all major sectors of the U.S. insurance market (Medicare, Medicaid and commercial plans). She has covered key legislation affecting biopharma, including the Medicare Prescription Drug, Improvement, and Modernization Act which created Part D, health care reform under President Obama, and the Inflation Reduction Act. She has closely followed the increasing influence of pharmacy benefit managers and their use of formulary negotiations and rebates to control pricing. Cathy also has covered developments in health technology assessments and has monitored industry progress on novel drug contracting that reflects value-based pricing.

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Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

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Managing Editor, Health Plan Weekly and Radar on Drug Benefits

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Reporter, Health Plan Weekly and Radar on Drug Benefits

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Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

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Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

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