2021-10-25-奥纬咨询-Medicare_Part_D_Benefit_Redesign_10页_235kb

Medicare Part D Benefit Redesign Analysis

Summary

The analysis examines the potential impact of proposed liability changes in the Medicare Part D benefit redesign by the House and Senate bills on national basic beneficiary premiums. Key changes include reducing federal reinsurance and increasing responsibilities for beneficiaries and manufacturers. Model simulations indicate that incremental increases in manufacturer liability in specific phases could significantly reduce projected premiums.

Proposed Changes in Part D Benefit Redesign

Build Back Better Act (H.R.3)

• Manufacturer Liability: 10% for brand drugs in the initial coverage phase (up to $2,000), 30% for amounts above.
• Elimination of Coverage Gap: Direct transition from initial coverage to catastrophic phase.
• LIS Impact: Liability percentages extended to low-income beneficiaries.

Prescription Drug Pricing Reduction Act of 2019

• Manufacturer Liability: 7% for brand drugs in the initial coverage phase (up to $3,100), 14% for amounts above.
• Elimination of Coverage Gap: Beneficiaries move directly from initial coverage to catastrophic phase.
• LIS Impact: Liability percentages extended to low-income beneficiaries.
• Initial Coinsurance: Reduced from 25% to 20%.

Impact on Premiums based on Manufacturer Liability Increases

• Build Back Better Act:
  • A 3.5% increase in initial coverage manufacturer liability reduces premium impact by ~$1 PMPM.
  • A 1.5% increase in catastrophic phase manufacturer liability reduces premium impact by ~$1 PMPM.
• Prescription Drug Pricing Reduction Act:
  • A 2% increase in initial coverage (from 7% to 9%) reduces premium impact by ~$1 PMPM.
  • A 2% increase in catastrophic phase (from 14% to 16%) reduces premium impact by ~$1 PMPM.

Comparison of Manufacturer Liability Percentages (Brand Drugs)

Key Conclusions

1. The proposed Part D redesign bills seek to reduce federal liability and increase responsibilities for manufacturers and beneficiaries.
2. Oliver Wyman analysis demonstrates that increasing manufacturer liability requires a smaller percentage point change in the catastrophic phase (1.5-2%) compared to the initial coverage phase (3.5-3.8%) to achieve a $1 reduction per month, per member (PMPM) in estimated national Part D basic premiums before buy-down.
3. The required incremental manufacturer liability increases differ between the two bills due to variations in proposed benefit structure characteristics.