Trump drug proposal may be costly for cancer patients

WASHINGTON — When President Donald Trump unveiled his plan to lower prescription drug prices in a Rose Garden speech last month, he said he would inject more competition into the market by bolstering negotiating powers under Medicare. But experts analyzing the plan warn of a possible side effect: The proposal could significantly increase out-of-pocket costs for some of the sickest people on Medicare.

At the heart of the president’s plan is a proposal to switch some expensive drugs from one part of Medicare to another part — moving them from Part B, the medical benefit created in the original 1965 Medicare law, to Part D, the outpatient drug benefit added by Congress in 2003.

Under Part D, the government contracts with private health insurance companies to manage the benefit and negotiate discounts with drugmakers. There is no such negotiation for the drugs covered by Part B, which are administered by infusion or injection in doctors’ offices or hospital outpatient departments.

But Medicare beneficiaries typically pay a larger share of the costs for Part D drugs. Many beneficiaries have supplemental insurance, such as a Medigap policy, to help pay their share of the bill for drugs covered under Part B. Medigap policies are not allowed to cover Part D expenses.

Under Part B, beneficiaries are generally responsible for 20 percent of the Medicareapproved charges for drugs and doctors’ services, but the most popular Medigap policies cover the beneficiary’s share. By contrast, in Part D, beneficiaries may be responsible for 30 percent of the cost of some drugs, or more, depending on the terms of coverage set by their drug plan.

Another potential problem is that 9 million Medicare beneficiaries who are enrolled in Part B do not have drug coverage under Part D. The White House has not said how their drug bills would be paid.

The public has until July 16 to comment on ideas in Trump’s blueprint and to recommend drugs that could be moved to Part D.