Trump administration proposes incremental drug pricing plan that puts onus on beneficiaries

Instead of taking big, bold steps to lower prescription drug prices, the Trump administration has rolled out yet another incremental measure that merely nibbles at the edges of the problem – while at the same time putting additional burdens on beneficiaries.  The Centers for Medicare and Medicaid Services (CMS) unveiled a new proposal this week that would limit coverage for drugs which treat several serious and chronic conditions:

“The Trump administration propose[s]… to cut costs for Medicare by reducing the number of prescription drugs that must be made available to people with cancer, AIDS, depression, schizophrenia and certain other conditions.” – New York Times, 11/27/18 

As the New York Times explains, insurance plans providing prescription coverage to Medicare beneficiaries would no longer have to cover all of the drugs in six “protected classes.”


*Antipsychotic medicines (to treat schizophrenia and related disorders)

*Immunosuppressant drugs (to prevent rejection of organ transplants)

*Anti-epilepsy drugs

*Antiretrovirals (for treating H.I.V./AIDS)

*Various Cancer drugs

Some 45 million Medicare beneficiaries currently receive coverage for at least one of these classes of medications.

“Rather than talk about these incremental measures, it’s time for U.S. to do what every other industrialized country does and allow Medicare to negotiate the cost of drugs,” says Lisa Swirsky, Senior Policy Analyst at the National Committee.

In a 2018 Kaiser Family Foundation poll, 92% of respondents said they favored empowering the federal government to negotiate lower drug prices for people on Medicare.  President Trump himself promised on the campaign trail to enact such a policy, but so far has not.

Democrats introduced legislation during the current Congress to allow Medicare to negotiate prescription prices, but GOP leadership refused to consider these measures.  The 116th Congress taking office in January will have an opportunity to breathe new life into this effort, which would go much further in knocking down drug prices than anything the administration has proposed.

Meanwhile, proposals like the one just announced by CMS put the onus on Medicare beneficiaries – despite administrator Seema Verma’s claims to the contrary.  Verma says that if seniors don’t like the restrictions in a drug plan, they can choose a different one.  But Swirsky says it is unrealistic to expect seniors to pore through hundreds of pages of policy documents to divine a plan’s rules regarding protected class drugs.  Far from putting seniors in the driver’s seat, as Verma insists, this proposal leaves them in the passenger’s seat – with Big Pharma at the wheel.