Medicare Monday: A guide to MedPAC’s Part D vote this week

Medicare Monday post provides a guide to MedPAC’s vote on a series of draft recommendations affecting the Part D program.

Allyson Funk
Allyson FunkApril 4, 2016

Medicare Monday: A guide to MedPAC’s Part D vote this week.


The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency that advises Congress on issues related to the Medicare program, including payment, access to and quality of care. We’ve looked at some of their analysis before in posts here, here and here.

Later this week, Thursday and Friday, April 7th and 8th, MedPAC will vote on a series of draft recommendations affecting the Part D program. Here are a few things to watch for:

1. Changes to Part D federal reinsurance, the coverage gap and beneficiary out-of-pocket spending

The first draft recommendation includes changes to lower the federal government’s share of Part D’s individual reinsurance subsidy, exclude 50 percent of manufacturer discounts in the coverage gap (also known as the donut hole) from enrollee true out-of-pocket (TrOOP) spending and eliminate beneficiary cost-sharing above the out-of-pocket threshold (Part D OOP cap). 

The TrOOP proposal would negatively impact beneficiaries by widening the coverage gap, increasing beneficiary out-of-pocket costs and significantly reducing the number of beneficiaries who would benefit from a Part D OOP cap. A recent Avalere Health analysis estimates the TrOOP change would increase beneficiary costs by $4.1 billion between 2017 and 2020 and 715,000 fewer beneficiaries would reach the out-of-pocket threshold each year, on average.

2. Changes to Part D Extra Help, also known as the low-income subsidy

The second draft recommendation would increase beneficiary copays for brand medicines while reducing them for generic medicines. These proposed changes would be harmful to Extra Help beneficiaries who are already the most vulnerable patients and to those beneficiaries taking a brand medicine for which there is no generic equivalent or medically appropriate substitute. See why changes to Extra help could be harmful for beneficiaries in Diane’s patient profile here and in a short video here.

3. Changes to the Part D protected classes policy

The third draft recommendation includes a proposal that would remove certain classes of medicines – including anti-depressants and immunosuppressants, anti-transplant rejection medicines – from the protected classes in Part D. Created to allow patients to access “all or substantially all” medications within six specific classes of medicines, this policy has helped patients receive important treatments for diseases like HIV, cancer and mental illness. Less robust coverage for these medicines could have serious consequences for patients managing these complex conditions and who need access to the full range of treatment options. See what leading health experts say about why Medicare Part D’s six protected classes are important for patients here.

tn_MedMon.jpgMany proposals on MedPAC’s current list of draft recommendations would significantly harm beneficiaries by shifting costs to vulnerable patients and jeopardizing access to needed medicines. Keep an eye on MedPAC activity later this week to see what happens with these draft recommendations.

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