The Trump administration released its American Patients First blueprint, a broad plan to lower the cost of prescription drugs and reduce patient out-of-pocket expenses, in May 2018. This would signal several new proposed regulations and guidance released in the past year, with more to come in 2019 and 2020. Although ASCs might administer and prescribe fewer drugs than other sites of services, the industry still needs to pay careful attention to the shifting regulatory landscape. For one, some changes targeting Part B drugs (physician administered) might directly affect ASC operation. And in a larger sense, ASCs can and should be advocates for patients having affordable, appropriate access to necessary medication.
Issues surrounding prescription drugs are often difficult to address; both the drug manufacturers and private insurance plans—the largest single payer for prescription drugs—can be powerful, organized opponents of change. With that in mind, a common path for addressing prescription drug issues has been proposing changes to Medicare Part D, which has grown in the past 15 years to comprise one third of all prescription drug spending. Medicare Part D provides coverage for self-administered prescription drugs to more than 43 million Medicare beneficiaries, either through standalone prescription drug plans (PDPs) or via their Medicare Part C (commonly called Medicare Advantage) plan. Although this benefit is now seen as an essential part of the Medicare program it is a relatively recent added benefit, coming out of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Although most view Part D as a successful addition to the Medicare program, the increase in overall expenditures on drugs has become a major policy concern. Estimates released by the Centers for Medicare & Medicaid Services (CMS) Actuary predict spending on prescription drugs could grow at an increased rate in coming years, with an average growth rate twice as high as recent years.
In response to these concerns the Trump administration released the aforementioned American Patients First blueprint, a broad plan that seeks to lower drug prices and reduce out-of-pocket costs for patients. The blueprint describes some actions that the administration has taken so far, mostly via proposed budgets and rule finalization, to address four key strategies for reform: improved competition, better negotiation, incentives for lower list prices, and lowering out of pocket costs.