On November 19, the U.S. House passed the Build Back Better (BBB) legislation, which contains wide-ranging provisions related to climate, social programs, and immigration. With regard to healthcare, the legislation includes several coverage and access provisions.
Relevant to rheumatology patients: the BBB reforms Medicare Part D cost-sharing by putting in place a much-needed annual cap on out-of-pocket costs for beneficiaries. Other drug pricing provisions include inflationary rebates and, disappointingly, a repeal of the so-called rebate rule, which was a regulation that would have outlawed payments from drug companies to pharmacy benefit managers in exchange for formulary placement. Finally, the BBB contains a government price negotiation mechanism for prescription drugs, which became more limited than initial proposals through the negotiation process.
CSRO has expressed concern about how this proposal would affect buy-and-bill providers and has joined other Part B medication providers to explore a legislative solution to remove providers from the mechanism altogether, while still providing beneficiaries with immediate cost-sharing relief and ensuring that Medicare experiences significant savings.
Next, the legislation will undergo extensive changes in the Senate, both as a result of substantive negotiations and procedural requirements. One overhang is the recent Congressional Budget Office score, which shows that the BBB will increase the deficit by $367 billion over ten years. The outcome is still unknown, and additional updates will be shared in future CSRO emails.