Caught my Eye
Surely a Coincidence. President Trump called for direct to consumer purchasing at Most Favored Nation Pricing and BlinkRx said that they could offer this service. Donald Trump Jr. is on their board.
Lobby Me This. Stat News had an article about a new coalition, IRA Watch, that is formed to discuss the consequences of the Inflation Reduction Act. As someone who works in this space a lot and just wrote a piece about the consequences of IRA Part B negotiation, I am looking forward to they might be doing.
Rainy Day. The Trump Administration issued an executive order moving toward stockpiling 26 essential drugs (TBD).
Science Keeps Taking the Hits. The Department of Health and Human Services is canceling $500 million in mRNA vaccine development.
CO.lor Me Doubtful. As Colorado’s prescription drug affordability board moves forward with its upper payment limit on Enbrel, patient advocates are sounding the alarm on what it could do to patient access.
Reviewing the Fundamentals – Medicare Advantage Prescription Drug Plan Enrollment
Medicare Advantage Prescription Drug (MA-PD) plans have had tremendous growth over standalone prescription drug plans (PDPs) over the past 20 years and, as we look ahead to $50/month premium growth in PDPs, we’re likely to see those enrollment numbers increase.
Between 2007 and 2018, MA-PD enrollment grew by an average of 9% annually, compared to 4% for PDPs. This disparity intensified between 2019 and 2023, with MA-PD enrollment soaring by 47% (9 million additional enrollees), while PDP enrollment decreased by 12% (3 million fewer enrollees).
This trend continued, with 58% of Part D enrollees choosing MA-PD plans by 2025. The growth in MA-PD plans is driven by financial incentives for both insurers and beneficiaries, and the availability of supplemental benefits like vision, dental, and hearing coverage.
Many MA-PDs plans offer low or even zero monthly premiums due to their ability to use Medicare rebate dollars to offset costs. As I covered a few weeks ago, some beneficiaries are locked into standalone prescription drug plans (PDPs) because of Medigap or because of where they live, but the drive to join an MA-PD plan is strong. One thing that beneficiaries have to remember is that while MA-PDs offer advantages like low premiums and extra benefits, they also often come with restricted provider networks and greater use of prior authorization compared to traditional Medicare.
FWIW, I LOVED this dashboard from the Centers for Medicare & Medicaid Services (CMS) showing the enrollment numbers over time (click on prescription drugs).
For the Files
JP Morgan report on the business of healthcare in 2025 with a ton of explanation and charts. It’s the kind of thing that, if you’re nerdy, you might want to pour over with a cup of coffee and settle in.
