Drug firms propose to fill 'doughnut hole': WSJ
A consortium of drug companies is working on a proposal that would help Medicare beneficiaries afford medicines during gaps in their Part D coverage, The Wall Street Journal reports.
Seven firms, including Johnson & Johnson, Novartis and Bristol-Myers Squibb, are involved in the effort, called Bridge Rx, according to the report. Astra Zeneca is weighing whether to join, and Pfizer too is considering the plan.
However, the effort may not achieve government sanctioning unless embraced by more drug companies, notes the WSJ. The OIG worries that companies could use patient assistance to steer patients to their products, potentially invoking the antikickback statute.
Medicare plans stop, or significantly lessen, payment for members' prescription drugs when their bills hit $2,250 a year, or amount to $750 in out-of-pocket costs. Plans resume after patient payments exceed $5,100, or $3,600 in out-of-pocket costs.
Bridge Rx would provide discounts of up to 50% on drugs to help certain low-income patients through the "doughnut hole," as the gap is known. Patients would have a co-pay of at least 15%.
CMS confirmed it is talking with the drug firms about the program, which the companies hope to announce in April and launch in May.
That is contingent on them wooing others to join, though. And while having a wide array of drugs, including generics, could allay government concerns, some companies are waiting to see what the OIG says before joining, according to the Journal.