Moving the Needle on Prescription Drug Costs: Using the Innovation Center and Other Demonstration Authority
| Appendix Table 1: Examples of Demonstrations Related to Prescription Drugs | |||
|
Demonstration Name |
Year | Description | Result |
| Section 402 | |||
| Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy | 2005 (modified significantly for 2006) | Asks chemotherapy patients questions about how they had responded to treatment and makes additional payment to oncologists for submitting this quality of life and patient care data | Concluded |
| Reimbursement of State Costs for Provision of Part D Drugs | 2006 | Reimburses States for drug costs and related administrative costs incurred during the transition period for full-benefit dually eligible beneficiaries to Medicare Part D | Concluded |
| Medicare Part D Payment Demonstration (also known as Medicare Part D Reinsurance Demonstration) | 2006 | Provides alternative methods of receiving reinsurance for drug costs above the “catastrophic” level for Part D plans offering enhanced coverage | Concluded |
| Medicare Demonstration to Transition Enrollment of Low-Income Subsidy (LIS) Beneficiaries | 2007 | Phase-in the enrollment weights methodology for regional benchmarks to maintain substantial availability of below-benchmark plans and minimize disruption to LIS beneficiaries | Concluded |
| Innovation Center | |||
| Medicare Advantage Value-Based Insurance Design (VBID) Model | 2017 | Tests a variety of payment and delivery approaches, including flexibilities targeted to Medicare beneficiaries based on chronic condition, one of which is reductions in cost sharing for covered Part D drugs | Ongoing through 2024 |
| Part D Enhanced Medication Therapy Management Model | 2017 | Provides basic, stand-alone prescription drug plans with flexibility to implement innovative medication therapy management programs with the goal of optimizing medication use | Ongoing through 2021 |
| Part D Payment Modernization Model | 2020 | Tests the impact of a revised Part D program design and incentive alignment on overall Part D prescription drug spending and beneficiary out-of-pocket costs | Ongoing through 2024 |
| Part D Senior Savings Model | 2021 | Allows Part D sponsors, through enhanced plans, to offer a Part D benefit design that limits out of-pocket costs for insulin to $35 a month | Ongoing through 2025 |
| Most Favored Nation Model | 2021 | Modifies payments for certain Part B drugs that contribute to high Part B spending to align more closely with international prices and also removes incentives for physicians to prescribe high-cost Part B drugs | Not yet in effect; HHS enjoined from implementing |
| NOTE: This table does not include Congressionally mandated models. | |||