Commission Recommendations
MedPAC makes recommendations to the Congress and to the Secretary of Health and Human Services on issues affecting the administration of the Medicare program. With its recommendations, the Commission strives to improve the delivery of care, while ensuring financial stability and maximizing value for the program. After extensive analysis and evaluation, our recommendations are discussed and voted on by Commissioners in our public meetings. Recommendations are typically published in two main reports, released in March and June of each year.
| Recommendations | Topic(s) | Date |
|---|---|---|
Medicare Part B drug payment policy issuesThe Congress should change Medicare’s payment for Part B drugs and biologicals (products) as follows: Modify the average sales price (ASP) system in 2018 to: require all manufacturers of products paid under Part B to submit ASP data and impose penalties for failure to report. reduce wholesale acquisition cost (WAC)-based payment to WAC plus 3… Read more » |
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June 2017 |
Improving Medicare Part D (1)The Congress should change Part D to: transition Medicare’s individual reinsurance subsidy from 80 percent to 20 percent while maintaining Medicare’s overall 74.5 percent subsidy of basic benefits, exclude manufacturers’ discounts in the coverage gap from enrollees’ true out-of-pocket spending, and eliminate enrollee cost sharing above the out-of-pocket threshold. |
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June 2016 |
Improving Medicare Part D (2)The Congress should change Part D’s low-income subsidy to: modify copayments for Medicare beneficiaries with incomes at or below 135 percent of poverty to encourage the use of generic drugs, preferred multisource drugs, or biosimilars when available in selected therapeutic classes; direct the Secretary to reduce or eliminate cost sharing for generic drugs, preferred multisource… Read more » |
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June 2016 |
Improving Medicare Part D (3)The Secretary should change Part D to: remove antidepressants and immunosuppressants for transplant rejection from the classes of clinical concern, streamline the process for formulary changes, require prescribers to provide standardized supporting justifications with more clinical rigor when applying for exceptions, and permit plan sponsors to use selected tools to manage specialty drug benefits while… Read more » |
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June 2016 |
Medicare Part B drug and oncology payment policy issuesThe Secretary should reduce the Medicare Part B dispensing and supplying fee to rates similar to other payers. |
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June 2016 |
Hospital inpatient and outpatient servicesThe Congress should direct the Secretary of the Department of Health and Human Services to: update inpatient and outpatient payments by the amount specified in current law; reduce Medicare payment rates for 340B hospitals’ separately payable Part B drugs by 10 percent of the average sales price; direct the program savings from reducing Part B… Read more » |
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March 2016 |
Hospital short-stay policy issues (5)The Congress should package payment for self-administered drugs provided during outpatient observation on a budget-neutral basis within the hospital outpatient prospective payment system. |
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June 2015 |
Status report on Part D, with focus on beneficiaries with high drug spendingThe Congress should modify the Part D low-income subsidy copayments for Medicare beneficiaries with incomes at or below 135 percent of poverty to encourage the use of generic drugs when available in selected therapeutic classes. The Congress should direct the Secretary to develop a copay structure, giving special consideration to eliminating the cost sharing for… Read more » |
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March 2012 |
Public reporting of physicians’ financial relationships (1)The Congress should require all manufacturers and distributors of drugs, biologicals, medical devices, and medical supplies (and their subsidiaries) to report to the Secretary their financial relationships with: * Physicians, physician groups, and other prescribers; * Pharmacies and pharmacists; * Health plans, pharmacy benefit managers, and their employees; * Hospitals and medical schools; * Organizations… Read more » |
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February 2009 |
Public reporting of physicians’ financial relationships (2)The Congress should direct the Secretary to post the information submitted by manufacturers on a public website in a format that is searchable by: * Manufacturer; * Recipient’s name, location, and specialty (if applicable); * Type of payment; * Name of the related drug or device (if applicable); and * Year. |
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February 2009 |