Proposed changes on Medicare drugs create winners and losers

WASHINGTON – The Trump administration on Monday proposed changes to Medicare’s prescription drug benefit that would affect people’s costs over the next few years, and create winners and losers.

Medicare’s administrator, Seema Verma, said the goal is to lower costs for beneficiaries and modernize the government’s flagship health insurance program for seniors and the disabled, covering about 60 million people.

The proposals apply to two popular parts of Medicare: private Medicare Advantage plans that offer comprehensive health care coverage, and prescription drug plans also offered by private insurers.

The proposal could create winners and losers among seniors, insurers, middlemen and drugmakers. Experts will pore over the details to assess the impact.

The changes include more leeway for insurers to exclude a specific drug in Medicare’s six “protected classes” of medications. The use of e-prescribing would grow.

Medicare Advantage insurers could require “step therapy” for drugs given in a doctor’s office, which means patients first have to try a lower-cost drug. Verma said safeguards in the proposed rule would protect patients.

The administration wants to change Medicare rules so a portion of rebates from drugmakers get passed on to patients when they pick up their medications at the pharmacy.