Part D:
Part D Overhaul Focuses On Value, Comprehensive Coverage
Published on Mon Jan 28, 2008
Price fixation may become the norm Health policy researchers Ruth Lopert, BMed, MMedSc, and Marilyn Moon, PhD, recommended in a Commonwealth Fund-supported study that outcome assessments of the Part D benefit should emphasize data on therapeutic value rather than drug pricing alone. "A long-term objective should be integrating drug benefits with comprehensive health coverage," said researchers in the Dec. 3 Commonwealth Fund release. They advised that the Centers for Medicare and Medicaid Services (CMS) develop a comprehensive plan to compete with private plans. A CMS plan would require a comprehensive but closed formulary, built on transparent, evidence-based assessments of comparative effectiveness and value for money, according to the researchers. As a result, there may be a limited number of generic or brand versions of drugs in the plan or the number of choices within a therapeutic class. Researchers further stressed that a CMS plan should abide by fixed cost-sharing arrangements and make beneficiaries aware of their fixed contributions. Researchers also recommended introduction of a reference pricing form or price fixation of drugs at the same level. This would not only control prices, according to Lopert and Moon, but would also "establish a conceptual framework in which Medicare coverage supports the purchase of health 'outcomes' rather than the drugs." In addition, researchers suggested that Medicare Parts A, B, and D be melded into an integrated benefit. "An integrated benefit with treatment options based on assessments of effectiveness and cost-effectiveness would ensure that early and judicious use of preventive drug therapies is encouraged by an understanding of downstream outcomes and cost offsets."