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Issue of Part D Cost Sharing for Preventive Services Arises at Senate Drug Pricing Hearing

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An April 9 hearing before the Senate Finance Committee entitled “Drug Pricing in America: A Prescription for Change” included discussion related to cost-sharing for preventive services in the Medicare Part D.
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In testimony, witness Derica Rice, executive vice president of CVS Health and CVS Caremark, discussed opportunities to improve the Part D benefit design. Rice raised the possibility in his testimony of implementing a list of preventive drugs that would have $0 cost-sharing. Rice noted that his company offers its employees a benefit plan with such a list that includes generic medications that help prevent chronic conditions, as well as some brand drugs, such as insulin.

Aligning on a definition of “preventive drugs” would be critical in implementing any proposed changes to Part D benefit design, especially because vaccines and PrEP for HIV are unique compared to drugs such as insulin that help manage chronic disease. Avalere has previously presented several options for accomplishing improved vaccine coverage in Medicare. Additionally, our recent Health Affairs blog post highlighted issues surrounding coverage of pre-exposure prophylaxis (PrEP) for HIV in Part D.

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