President Donald Trump told his administration Tuesday to find ways to reduce what people with Medicare pay for prescription drugs and Medicare prescription drug coverage.
Trump put the instructions in a new executive order that calls for Robert Kennedy Jr., who is Health and Human Services secretary, and officials in the White House to lower prescription drug costs.
For clients with Medicare coverage, the biggest direct effect could be drug plan benefit changes.
The order could also lead to changes in a big new Medicare drug price negotiation program and in rules that affect whic drugs reach pharmacy shelves.
What it means: For many older clients with Medicare, drug coverage changed a lot this year. Their drug coverage could soon change a lot again.
Medicare drug coverage basics: Medicare is a federally funded program that provides coverage for about 64 million people who are ages 65 or older, disabled or facing severe kidney disease.
Enrollees can get prescription drug coverage either through Part D coverage built into their Medicare Advantage plans or through stand-alone Part D prescription drug insurance policies.
Drafters of the Inflation Reduction Act of 2022 tried to help people with high drug bills by preventing Part D coverage enrollees from spending more than $2,000 of their own money on covered drugs.
Some insurers reacted to the $2,000 cap by leaving the Medicare drug plan market.
Other insurers tried to compensate by increasing premiums and deductibles and making other coverage changes.
The 2022 law also includes a provision that lets the Centers for Medicare and Medicaid Services, the HHS agency that runs Medicare, negotiate with manufacturers to hold down rates for some drugs.
Medicare benefits provisions: The new order tells the HHS secretary and officials in the White House to "provide recommendations to the president on how best to stabilize and reduce Medicare Part D premiums" within 180 days.
That provision could create a response to the impact of the current $2,000 cap on out-of-pocket spending.
The order also tells the HHS secretary to:
◆ Develop guidance, within 60 days, for updating the Medicare drug price negotiation program. The program is supposed to be more open, focus more on higher-cost drugs and minimize the impact on efforts to develop new drugs.
◆ Develop a rulemaking plan, within one year, for helping the Medicare program get "better value" for all high-cost prescription drugs and biological products covered by Medicare.
Other provisions: Some of the other executive order provisions could affect drug access and drug prices for all patients.
Officials are supposed to:
◆ Keep drug manufacturers from crowding out competition.
◆ Ease barriers to drug imports.
◆ Make it easier to let safe prescription drugs be sold without a prescription.
The future: One question is whether the Trump administration can achieve the goals of the executive order without legislation.
If the administration does need legislation to move forward, it could face resistance.
Sen. Ron Wyden, R-Ore., put out a statement suggesting that the main goal of the order is to weaken the Medicare drug price negotiation program.
"Democrats created Medicare's drug negotiation authority without a single Republican vote," Wyden said. "Now is the time for Trump to faithfully follow the law Congress passed without watering it down at Big Pharma's request.”
But some of the executive order provisions are based on bills that have had strong bipartisan support.
About 81% of people over age 50 in an AARP survey earlier this year agreed that it was very or extremely important for the government to do more to lower prescription drug costs.
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