A legislative package designed to help address the opioid crisis will not include the “doughnut hole” fix, a key provision sought by the pharmaceutical lobby to lower the portion of the cost of a drug the industry must cover under Medicare, sources told the Washington Examiner.
The Pharmaceutical Research and Manufacturers of America was trying to insert a measure into the bill, expected to be finalized as early as Tuesday evening, to overturn a provision included in a February government spending bill that will force the drug industry in 2019 to begin to cover 70 percent of the price of treatments offered in the Medicare Part D program.
The influential lobbying group was trying to lower that discount for enrollees to 63 percent and sought to pair it with a proposal the industry previously opposed that would make it more difficult for pharmaceutical manufacturers to abuse a safety program at the Food and Drug Administration to prevent generic competitors from reaching the market.
Barring any last-minute deal, the package pushed by PhRMA is not expected to be added to the opioids legislation. Text of the negotiated bill could be released as soon as Tuesday evening, sources said.
At issue is the gap that Medicare Part D participants face after crossing a certain coverage threshold, when they are then required to pay a larger portion of the price of a brand-name drug before reaching the catastrophic-coverage level. Obamacare eliminated the so-called “doughtnut hole” in 2020, but the February spending bill lowered the portion that Medicare beneficiaries have to pay for treatments in 2019 to 25 percent until they reach that catastrophic level.
The increased requirement on pharmaceutical manufacturers that offer drugs in the program — like Eli Lilly & Co. and Novo Nordisk — is expected to add billions of dollars in cost.
Sen. Rob Portman, R-Ohio, also told the Washington Examiner that the final package would include a repeal of some sort of a decadesold rule that prevented hospitals from caring for more people with mental illness or substance abuse issues.
The Institution for Mental Disease, or IMD, rule prevents Medicaid from reimbursing a hospital that allows more than 16 people suffering from mental illness or addiction to staying at the hospital.
The House passed a partial repeal of the rule, but the Senate’s version of the legislation that passed last week did not include any repeal of the rule.
Portman and several other senators introduced a bill last week that would completely repeal the rule. Democratic Sens. Dick Durbin of Illinois, Ben Cardin of Maryland, and Sherrod Brown of Ohio were also co-sponsors of the Improving Coverage for Addiction Recovery Expansion Act.
Portman said that a version of his bill made it in to the final package, but did not elaborate.
