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House Vote on Medicare Drug Prices This Week

What with “All Impeachment All The Time" news on television, in newspapers and the internet, it's hard to know there are other things going on in Washington, D.C. But I did come across one last week that is important to most of the people who read this blog.

According to a press release at the House website of Speaker Nancy Pelosi, the U.S. House of Representatives this week will vote on H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act. The legislation will give Medicare

”...the power to negotiate lower drug prices and make those prices available to people with private insurance [Part D]. No longer will Americans have to pay more for their prescriptions than what Big Pharma charges in other countries for the same medicines.

“We are reinvesting the more than half a trillion dollars the federal government alone saves from lower drug prices to expand Medicare to cover vision, dental and hearing for the first time. We add billions to the search for breakthrough cures and treatments, confronting the opioid epidemic, strengthening our community health centers, and more.”

There are 106 co-sponsors of the bill, all Democrats. Text of the bill is here.

The White House opposes the bill primarily on grounds that it will prevent drug companies from creating new life-saving drugs. You can read the White House response here.

On the other hand, The Journal of Clinical Pathways reports

”Republicans in Congress have expressed concerns with the legislation citing, like the White House, that it would discourage innovation in new pharmaceutical product development, but the President has nevertheless praised Pelosi’s plan.”

Neither the publication nor I have a source for the president's praise.

Meanwhile, under current regulations, Part D costs to enrollees will increase next year. According to a Kaiser Family Foundation (KFF) analysis of changes for the year 2020:

”...Medicare Part D enrollees are facing a relatively large increase in out-of-pocket drug costs before they qualify for catastrophic coverage.

“This is due to the expiration of the ACA provision that constrained the growth in out-of-pocket costs for Part D enrollees by slowing the growth rate in the catastrophic threshold between 2014 and 2019; in 2020 and beyond, the threshold will revert to the level that it would have been using the pre-ACA growth rate calculation.

“For 2020, the out-of-pocket spending threshold will increase by $1,250, from $5,100 to $6,350.”

Here's the chart:


Further increases for Part D enrollees, according to KFF, include

”...higher out-of-pocket costs in 2020 for the deductible and in the initial coverage phase, as they have in prior years.

“The standard deductible is increasing from $415 in 2019 to $435 in 2020, while the initial coverage limit is increasing from $3,820 in 2019 to $4,020 in 2020.

“For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs, with plans paying the remaining 75% of generic drug costs—which means that, effective in 2020, the Part D coverage gap will be fully phased out.”

There are additional changes (what else is new) that you can read here.

H.R. 3 is not the only proposal in Washington to modify Part D costs. There is a bill from the Senate Finance Committee (SFC) and another from the Trump administration's fiscal 2020 budget (TAdmin). They would cap enrollees' out-of-pocket spending as follows:

H.R. 3 – at $2,000 out-of-pocket
SFC – at $3,200 out-of-pocket
TAdmin - Unknown

Here's the chart:


Whew. I'm nearly cross-eyed from sorting out all this information and trying to translate it from the government-ese. With that, I've left out a lot but you now have the general idea. You can get more detail from the links above.

Even given that no House Republicans signed on as co-sponsors, H.R. 3 is likely to pass in the House this week.

Over the past three years we have learned what happens to Democratic sponsored bills when they get to the Senate. But if you think this is a good proposal, you should urge your representative to vote for the bill – even if you already know he or she will do so. At least their offices will have tallies of constituents' leanings.

The Congress telephone number is (202) 224-3121, then ask for your representative's office by his/her name. Or, go to the House of Representatives website and enter your Zip Code to reach your representatives page.


Surely even Republicans have parents and grandparents.

I have Kaiser. I like Kaiser. And it's better than it was decades ago--in those days people got Kaiser when they couldn't afford anything else. These days, rich people often choose it for its quality.

However. As recently as the early '90s, my group plan had no copayment. Zip. Then, a few years later, they introduced a $1 copayment. Uh-oh, I said. And today, as a member of that same group plan, I have to pay $20 out of pocket to see the doctor. Not a lot, except I'm a dessicated little old crone (with a Herculean sense of humor) on a very small fixed income. And that $20 is twenty times higher than in the mid-'90s, and an infinity% higher than free covered health care.

Appreciate the time and effort you’ve put into deciphering all the data you’ve presented here — especially considering also the energy that had to be expended doing so. It’s pretty obvious what groups are trying to address controlling health care costs.

Also, it’s important we know our Representatives continue efforts on our behalf along with pursuing efforts to preserve our democratic republic via impeachment proceedings against a leader who believes his actions are above the law. So many bills have been smothered in the Senate as McConnell doesn't even allow them to come up for a vote so guess we know where this bill is headed. Will they ever be held accountable for undermining our democracy?

Even if the Republicans are correct about big pharma not wanting to do research for new meds, it still does not explain why Americans have to bear the burden for that research while other countries receive the benefits.

I don't buy the tRump Administration's argument about catastrophic consequences to medical innovation. What's the point of Big Pharma developing new "wonder drugs" anyway (many of which may be deemed "experimental" initially) if insurers won't pay for them and patients can't afford them? Who other than the wealthy can pay $10,000+ per dose for a drug no matter how miraculous it may be?

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