U.S. Senator John Thune (R-South Dakota) along with Senator Debbie Stabenow (D-Michigan) today introduced bipartisan legislation that would establish a Medicare Advantage (MA) demonstration program to evaluate how value-based insurance design (V-BID) could reduce MA enrollees’ copayments and coinsurance for some beneficiaries with specific chronic conditions for certain high-value medications and services and result in better health outcomes and reduced overall health spending.
“A central challenge in reforming America’s health care system is finding policy solutions to lower the cost of health care while improving patients’ health,” said Thune. “Rather than spending more on health care, money should be spent more wisely to improve the value of care delivered. V-BID is a promising health insurance concept that creates the potential for improving health care quality and reducing costs at the same time. It’s a win-win for patients and taxpayers.”
V-BID is an insurance design concept that reverses the current one-size-fits-all approach to cost-sharing by embracing the simple, yet transformative idea that prices for prescription drugs and services should be structured to motivate patients to make healthy choices. When patients forego high value medications or health care services due to cost, they are more likely to suffer adverse, and often serious events that could have been prevented, ultimately driving up the cost of care. Studies show that reducing or eliminating co-payments for high-value prescription drugs can increase their utilization, and ultimately improve clinical outcomes and lower health care expenditures.
This legislation would allow participating MA plans the option to use V-BID benefits to lower copayments and coinsurance to encourage the use of specific, evidence-based medications or clinical services and/or specific high-performing providers. It also explicitly prohibits plans from increasing copayments or coinsurance to discourage use of services in order to protect seniors.
Representatives Diane Black (R-Tennesse-06) and Earl Blumenauer (D-Oregon-03) have introduced companion legislation in the House of Representatives.