The Astellas Way Blog

Modernizing Medicare Part D: Productive Partnerships and Innovative Ideas

Jul 17, 2019

Last month, Astellas partnered with The Hill, a leading news outlet covering Congress and public policy issues, to host a forum in Washington, D.C. on ways to modernize the Medicare Part D program. A key theme of the day was collaboration.

The event brought together health care experts, patient advocates, various stakeholders and lawmakers from both sides of the aisle – U.S. Representatives Doris Matsui (D-CA) and Brett Guthrie (R-KY). It was encouraging to hear all participants step away from the finger pointing that too often dominates health policy discussions and lean toward problem solving. You can view highlights of the program here.

One of the primary discussion points was how to address the high out-of-pocket costs faced by seniors who need specialty medicines to tackle their diseases or conditions.

As I shared in my opening remarks, over the past 13 years Medicare Part D has provided seniors with affordable access to the medicines they need to stay healthy. However, the profound leaps we’ve witnessed in medical innovation have outpaced the program’s benefit design.

In 2005 – the year before Medicare Part D was created – the Food and Drug Administration approved two new medicines to treat cancer. Last year, the agency approved 48 new oncology medicines.

This innovation has translated into improved outcomes for patients. In recent years, we have seen reductions in the U.S. cancer mortality rate. Just this past May, the Centers for Disease Control and Prevention announced that from 1999 to 2017, there was a 19% drop in cancer deaths among adults aged 45 to 64. In many cases, these advancements also have brought notable qualitative improvements for patients, including reduced toxicity and the ability to take a medicine in the comfort of their home instead of in a hospital or clinic.

Lowering Out-of-Pocket Costs for Seniors

Medicare Part D has not evolved accordingly. Far too many seniors are facing high out-of-pocket costs that not only strain their budgets, but also can cause patients to abandon prescribed treatments and not receive the care that they need.

Encouragingly, this topic has been gaining attention from a broad range of stakeholders – from healthcare coalitions to policymakers – and there appears to be a palpable opportunity for constructive, positive change.

This is becoming more urgent by the day. By the year 2030, every member of the baby boom generation will be over 65 and one of every five Americans will have reached retirement age. 

I’m proud that Astellas has taken a forward-leaning role in offering productive solutions, which I initially shared in an article in STAT and we conveyed in more depth in recent comments to two committees in the House of Representatives.

Although the Administration has unfortunately withdrawn its rebate reform proposal, we need to continue to explore ways to pass negotiated rebates in Part D directly to seniors at the pharmacy counter. In addition, other policy approaches can make a meaningful difference in addressing affordability for patients.

For example, we are encouraged by ongoing discussions among members of Congress to implement an out-of-pocket spending cap for Part D beneficiaries. We believe that seniors should be able to space their costs over time rather than requiring payment up front – a flexibility that could ease their financial pressures. We also support lower cost sharing for patients, even if their drug is not on an insurer’s preferred tier, when their physician believes it is the most effective treatment for their condition.

Collaborative Precedents

Constructive change requires voices and ideas from across the healthcare ecosystem and the political spectrum.  Our engagement in such forums and discussions reflect the collaborative mindset that is inherent in The Astellas Way.

In the past, we’ve seen great examples of bipartisan, collaborative determination to enhance regulatory processes to keep pace with emerging science. The 21st Century Cures Act and reauthorization of the Prescription Drug User fee Act come to mind.

Now is the time to modernize Part D in a manner that equally prioritizes future innovation and affordable access to cutting-edge medicines – and we remain committed to being an active participant in the process so that together we can meet the health care needs of seniors.