Senate Finance leaders introduce outline of legislation to lower drug prices

Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Ore., today released a description of the chairman’s mark, the Prescription Drug Pricing Reduction Act of 2019, a bipartisan bill to lower the price of prescription drugs.
 
Among other provisions, the bill would make a number of changes to the Medicare Part D program, including reducing beneficiary cost-sharing responsibility and tying drug price increases to the rate of inflation. The bill also would require that more information around pharmacy benefit manager practices and manufacturer drug pricing be made publicly available.
 
The bill also changes how Medicare calculates Part B prescription drug payment amounts to lower spending and beneficiary out-of-pocket costs. Among other Part B changes, the bill would apply “site-neutral” payment cuts to drug administration services furnished in grandfathered off-campus provider-based departments. It also would cap at $1,000 the add-on payment for each Part B drug paid under the average sales price or wholesale acquisition cost methodology.
 
For Medicaid-related provisions, the bill would allow Medicaid to pay for gene therapies for rare disease through new risk-sharing value-based agreements; apply pressure on manufacturers to lower list prices and report more accurate calculations of their rebate obligations; and prevent spread pricing in the Medicaid program by PBMs.
 
In addition, the bill would increase the Medicaid rebate cap from 100% to 125% of a drug’s average manufacturing price, intended to discourage drug manufacturers’ price increases in non-Medicaid markets. It also would allow states the option to apply the Medicaid drug rebate requirements to drugs provided in outpatient hospital services through bundled or value-based payment arrangements.
 
The committee will mark up the bill on July 25.