Two key health provisions in the House “BBB “ would empower CMS to negotiate the prices of 10 drugs starting in 2023 and put a limit of $2,000 on Medicare Part D annual out-of-pocket costs.
Two key provisions in the House “BBB “ are CMS negotiation of the prices of 10 drugs starting in 2023 and an annual out-of-pocket maximum of $2,000 for Medicare beneficiaries who buy Part D coverage.
The climate change and family leave parts of the $1.75 trillion Build Back Better legislation that passed the House on Friday grabbed most of the attention. But the gigantic bill also has a large number of provisions affecting American healthcare. Now the Senate is taking up the bill, and it’s difficult to say which of healthcare provisions will be modified — or perhaps scrapped altogether. Of course it is uncertain whether the Senate will pass a “BBB” bill. Regardless of the outcome the House bill is the starting point for the all the upper house horse trading that is getting start.
Here are five of the important healthcare provisions in the House Build Back Better bill:
Cap on Medicare out-of-pocket drug expenses. Starting in 2024, Medicare beneficiaries with Part D coverage would have a $2,000 annual limit on their out-of-pocket expenses. The bill also caps insulin costs at $35 per month.
Medicare coverage of hearing aids and other hearing services. Vermont Senator Bernie Sanders is pushing for Medicare coverage of dental and vision services as well as hearing aids and other hearing services. Still, hearing aid coverage is a win for Sanders, who championed Medicare for all as a candidate for the Democratic presidential nomination in 2020.
Limited CMS negotiation of drug prices.Many Democrats have wanted empower CMS to use the Medicare program’s buying power to negotiate drug prices. The House bill includes a provision that would empower the agency to the prices of up to10 drugs in 2023 and up to 20 later on.
ACA subsidies extended to the non-Medicaid expansion states. People without health insurance in the 12 states (most of them in are in the South) that haven’t expanded Medicare would be eligible for subsides of coverage purchased on the ACA exchanges. According to the Kaiser Family Foundation, the 2 million people could gain healthcare insurance coverage if this provision of the House bill becomes law.
Conversations With Perry and Friends: Paul Fronstin, Ph.D.
May 9th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. In this episode, his guest is Paul Fronstin, Ph.D., director of health benefits research at the Employee Benefit Research Institute.
Listen
Iowa Expands PBM Legislation to Address Concerns of Independent Pharmacies
May 16th 2025A new law in Iowa, if signed by the governor, will mandate 100% pass-through of rebates, increased financial transparency, and a minimal payment for pharmacies. Critics say it will be the most costly mandate in the state’s history.
Read More
Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
Listen
FDA Approves First At-Home Cervical Cancer Screening Device
May 15th 2025Self-collected samples to test for cervical cancer are a step in the right direction when it comes to addressing healthcare barriers, according to Rahma S. Mkuu, Ph.D., M.P.H., assistant professor in the Department of Health Outcomes & Biomedical Informatics at the University of Florida College of Medicine.
Read More