Medicare Part D Facts Keep Getting in the Way of Politics

It’s campaign season, so that means we’re seeing an escalation in the number of politicians who insist that the federal government must involve itself in “negotiating” prices for the Medicare Part D prescription drug program. (I put negotiating in quotations because it’s a misnomer to suggest that government negotiates in the understood sense of the world. It is closer to reality to say that the feds set prices.)

The problem with this assertion regarding Medicare Part D is that the facts keep getting in the way.

Last week, the Centers for Medicare and Medicaid Services announced that average monthly premiums for Part D plans are expected to drop from $33.59 in 2018 to $32.50 in 2019. This is the second consecutive year in which average premiums will have declined and follows several previous years in which premium levels remained relatively flat. In other words, the inference that urgent action is needed to fundamentally change the Medicare Part D structure isn’t supported by any evidence that consumers are being harmed by the status quo.

In fact, the approach employed when Congress created the Medicare prescription drug program just over a decade ago remains just as viable today. The best way to maintain affordability is to empower consumers to select from several competing drug plans on the basis of value. Part D enrollees will naturally gravitate to the plans that cover the drugs their physicians prescribe and do so at affordable cost.

That’s not to say there aren’t actions that need to be taken regarding Part D. For example, Congress needs to act expeditiously to address the “out of pocket cliff,” the forthcoming change in the out-of-pocket spending threshold that must be met in order to qualify for catastrophic coverage. If not address, this “cliff” will cost beneficiaries several hundred dollars that many can’t afford.

On the whole, though, when politicians tell you this political season that we need a heavier government hand in Medicare Part D pricing, please be aware that the numbers don’t back up that claim.