The Medicare Part D drug pricing proposals in President Trump's 2019 federal budget proposal includes a policy to exclude manufacturer discounts in the coverage gap from beneficiary out-of-pocket totals, which is likely to generate significant push-back from manufacturers and patients.
The out-of-pocket proposal will lower Medicare costs by $47bn over 10 years, the budget projects
Excluding the discount from spending totals would undercut plan incentives to encourage seniors to use costly brands in order to accelerate beneficiaries progress through the gap into the catastrophic care phase of the benefit, when Medicare picks up the majority of costs, the budget document explains