As the nation's leading independent, nonprofit health information source for women, HealthyWomen is concerned about proposals and activities that can undermine the quality and value of health care for women. Therefore, we are concerned about the provision in the Senate budget bill that would undermine the structure and insurance benefit of the Medicare Part D program. Specifically, by restructuring the benefit so that Medicare Part D plans have no financial exposure in the coverage gap (a.k.a. donut hole), Part D plans would no longer have incentives to act as partners with Medicare beneficiaries – and fiduciary representatives – to ensure that patients are getting the most clinically and cost effective medicines at the best prices.
In health insurance discussions, the term "skin in the game" is often used to describe the situation where stakeholders have some financial interest in managing health care to provide the best value and outcomes for patients. Taking away the Part D plans' "skin in the game" in the coverage gap undermines this concept and the important role Part D plans serve as effective negotiators on behalf of Medicare beneficiaries.
"Part D helps nearly 42 million Americans afford prescription drugs by fostering private negotiations that reduce drug costs. If passed, the new provision – that has not been discussed in hearings or recommended by MedPAC – would undermine the negotiation process and hurt older adults and the disabled who rely on Medicare Part D. Thus, we urge Congress to discard this provision, and continue to maintain a patient-centered approach for Medicare's coverage and benefits in Part D and in the entire Medicare program," says Beth Battaglino, RN, CEO, HealthyWomen.