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Advising the Congress on Medicare issues
MedPAC > Recommendations > Realigning incentives in Medicare Part D (1)

Realigning incentives in Medicare Part D (1)

June 15, 2020

The Congress should make the following changes to the Part D prescription drug benefit:

  • Below the out-of-pocket threshold:
    • Eliminate the initial coverage limit.
    • Eliminate the coverage-gap discount program.
  • Above the out-of-pocket threshold:
    • Eliminate enrollee cost sharing.
    • Transition Medicare’s reinsurance subsidy from 80 percent to 20 percent.
    • Require pharmaceutical manufacturers to provide a discount equal to no less than 30 percent of the negotiated price for brand drugs, biologics, biosimilars, and high-cost generic drugs.

Appeared in: June 2020 - Chapter 5

Topics: Beneficiaries and coverage and Drugs, Devices, and Tests.