METHODOLOGY: POTENTIAL IMPACT OF CHANGES ON PATIENT OOP
▪ In order to gauge the impact of the various proposals on patient OOP, Xcenda built patient profiles of example patients with various conditions
▪ Assumptions
– Pharmaceutical profile was built by a pharmacist
– Premiums were not factored into OOP
– Drug prices were obtained through Medicare.gov using the 2020 standard benefit design for standalone prescription drug plans (PDPs) in the example patient profile’s area
- 2020 drug prices were increased by 11.8% to estimate drug costs in 2022. This reflects the increase seen in the benefit design in the Medicare Trustees Report.
– Parameters are considered fully phased-in in 2022 (ie, reinsurance liability represents parameters for “2024 and subsequent years”)
– Impacts of other provisions of the bills (such as Title 1 of H.R. 3, potential spreading out beneficiary OOP liability over multiple months) and other provisions/implications (impact on innovation) are not reflected in the profiles unless noted otherwise
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