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On May 23, 2019, Ways & Means Committee Chairman Richard E. Neal (D-MA) and Energy & Commerce Committee Chairman Frank Pallone, Jr. (D-NJ), along with Ranking Members Kevin Brady (R-TX) and Greg Walden (R-OR) announced a solicitation for comments on draft legislation to reform the Medicare Part D program that would establish an out-of-pocket cap for Medicare beneficiaries.

Drafted in collaboration with other beneficiary-focused organizations, the Center for Medicare Advocacy submitted comments to the committees (all of the submitted comments, along with the committees’ solicitation, are available here).

In our comments, the Center supported adding an out-of-pocket cap in the Part D benefit at a level that will provide meaningful relief for individuals.   We also suggested improving the Part D Low-Income Subsidy (LIS), or Extra Help, by eliminating the asset test and expanding eligibility and eliminating cost-sharing for generic drugs for those with LIS.  We also recommended fixing the flaws in the current Part D exceptions and appeals process, including requiring plans to issue individually-tailored notices at the pharmacy counter when a drug is denied, and allowing such a denial to trigger an appeal right (instead of requiring an individual to follow up with his or her plan in order to request a coverage determination that could then trigger an appeal right).   We also urged the committees to consider allowing tiering exceptions for drugs placed in plans’ specialty tiers, as well as allowing the current, more consumer-friendly off-label drug use standards in Part B to apply to off-label coverage for Part D drugs.

June 13, 2019 – D. Lipschutz

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