"BBB" Bill Aims to Address CMS Drug Prices, 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 5 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.