Increases in Reimbursement for Brand-Name Drugs in Part D

U.S. Department of Health & Human Services, Office of Inspector General, June 2018

What OIG Found

* Total reimbursement for all brand-name drugs in Part D increased 77 percent from 2011 to 2015, despite a 17-percent decrease in the number of prescriptions for these drugs.

* After accounting for manufacturer rebates, reimbursement for brand-name drugs in Part D still increased 62 percent from 2011 to 2015.

* Part D unit costs for brand-name drugs rose nearly 6 times faster than inflation from 2011 to 2015.

* The percentage of beneficiaries responsible for out-of-pocket costs of at least $2,000 per year for brand-name drugs nearly doubled across the 5-year span.

Conclusion

We found that, over a 5-year period, increases in Part D reimbursement for brand-name drugs outpaced inflation. Despite a decrease in utilization of brand-name drugs, these substantial increases in reimbursement led to greater Medicare spending and higher beneficiary out-of-pocket costs for these drugs. Specifically, total Part D reimbursement for all brand-name drugs increased 77 percent, from $58 billion in 2011 to $102 billion in 2015. To control for the possibilities that (1) increases in utilization or (2) newer, more expensive brand-name drugs may have affected total Part D reimbursement, we analyzed the number of prescriptions and unit costs for brand-name drugs that were reimbursed in every year from 2011 to 2015. Overall, we found that utilization decreased for the majority of these brand-name drugs, while the average Part D unit cost increased 29 percent from 2011 to 2015.

Increases in Part D unit costs significantly outpaced inflation; in fact, the average unit cost for brand-name drugs in Part D rose nearly 6 times faster than inflation from 2011 to 2015. We also found that Part D unit costs closely followed the upward trend in benchmark prices, which are typically reflective of manufacturer prices. Therefore—like the 2016 ASPE report, which suggested that increases in drug prices contributed to the growth in total prescription drug spending—we conclude that increases in unit prices for brand-name drugs resulted in Medicare and its beneficiaries’ paying more for these drugs.

We also found that the percentage of beneficiaries who were responsible for out-of-pocket costs of at least $2,000 per year for brand-name drugs nearly doubled across the 5 years. These trends are consistent with those described in the previous OIG report, which found increases in the number of beneficiaries who reached the catastrophic-coverage phase of their Part D benefits. In addition, we found that total beneficiary out-of-pocket costs were highest for brand-name drugs in three therapeutic classes of maintenance drugs (insulins, cholesterol reducers, and respiratory tract corticosteroids). Because maintenance drugs are typically used to treat chronic, long-term conditions, increasing reimbursement for these drugs will continue to affect Part D and its beneficiaries for years to come. OIG remains committed to examining these issues and working with CMS to ensure the integrity of the Part D program.

https://oig.hhs.gov…

Probably the most significant finding in this OIG study is that the unit costs (prices paid) for brand-name drugs in Medicare Part D rose six times faster than the rate of inflation. Although the use of brand-name drugs has declined 17 percent, the total reimbursement has increased 77 percent because of these unit cost increases.

These escalating unit costs are borne by both the taxpayers who fund Medicare and the patients who are paying higher out-of-pocket costs. The spending increases have been particularly burdensome for patients requiring maintenance drugs for chronic conditions.

We do not have to continue to put up with this. Last month, a group associated with Physicians for a National Health Program released a proposal that would ensure universal access to safer, more innovative, and more affordable drugs. The report can be accessed at the following link:

http://www.pnhp.org/pharma

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