Organizations React to 2020 Medicare Part B Increases

Organizations reacted this week to news that CMS is raising Part B premiums with a variety of opinions, as CMS blamed rising drug prices for the increase.

“The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs,” CMS said last week. “These higher costs have a ripple effect and result in higher Part B premiums and deductible.”

Yearly adjustments to all parts of Medicare are made according to the Social Security Act. For 2020, the new costs for most beneficiaries are:

• Standard monthly premium: $144.60, an increase of $9.10 from $135.50 in 2019.
• Annual deductible: $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.

The majority of beneficiaries (70%) pay the standard amount; a minority of upper-income beneficiaries pay more. However, the standard increase for Part B in 2019 was much more modest ($1.50); in addition, the CMS announcement follows a small (1.6%) cost-of-living adjustment to 2020 benefits in 2020, which was pointed out by the AARP.

“This announcement is another clear example of how prescription drug prices are rising faster than inflation and how drug company greed is hurting seniors. With Medicare premiums increasing nearly 7% while Social Security payments will increase less than 2%, Congress needs to immediately act to lower prescription drug prices,” said Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer.

The Biosimilars Forum also chimed in, criticizing Congress and the administration for not doing enough to increase access to biosimilars, saying that the 9 biosimilars available in Part B cost about 30% less than the reference products. They said that beneficiaries “are often denied access to or unaware a lower-cost option exists due to misaligned incentives that favor the higher-cost product.”

The forum, which represents 8 biosimilar developers, has been advocating for ending out-of-pocket cost for biosimilars, saying such a move could save as much as $3.3 billion and increase access. In the statement, the forum highlighted 3 bipartisan bills that have been introduced in Congress:

• The Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars (ACCESS) Act, or HR 4597, would end a patient’s copay for a biosimilar under Medicare Part B through subsidies, regardless of the patient’s type of coverage, and without any other changes to the underlying coverage.

• The Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act, or HR 4455, would temporarily increase reimbursements for biosimilar drugs and boost their utilization by doctors.

• The Star Ratings for Biosimilars Act, or HR 4629, would implement an access measure to incentivize Medicare Advantage and Part D plans to improve access to biosimilars on their formularies.

The BIOSIM act is also included in the drug pricing plan preferred by House Speaker Nancy Pelosi, D-California, although it will not be considered by the Senate, even as seriously ill beneficiaries continue to struggle with healthcare costs. Meanwhile, President Trump is said to prefer a bipartisan Senate bill, but that does not have unanimous Republican support either.