Changes in Medicare Part D Benefit Design Can Impact Availability of Future Treatments

The Medicare prescription drug benefit (Part D) is considered by many to be a model of a successful government insurance program. Beneficiary premiums have declined 13.5% over the past 5 years, and most regions of the country have many prescription drug plan options for beneficiaries. Despite these laudable outcomes, Part D is not perfect, and its age is showing as the prescription drug market continues to evolve.

Xcenda was commissioned on behalf of the Rare Access Action project to conduct research and analysis on the impact of Part D benefit designs on orphan drug manufacturers. We found that for the modeled disease states, manufacturer obligations increased by a minimum of 400%.  The range in the proposal from the Senate Finance Committee indicated an increase in drug manufacturer cost from 400 to 800%. And the situation was even more stark in evaluating House proposals. Under HR 3, manufacturer obligations rose from 1,000 to 2,000%. The magnitude of these increases could change the way investors approach the rare disease market and their appetite for funding innovative orphan treatments.