PCMA requested that Milliman estimate the impact of shifting price concessions reflected as DIR to price concessions at the POS over a ten-year projection period (2017-2026) on individual PDP stakeholders, including the federal government, beneficiaries, and pharmaceutical manufacturers.

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Key Findings

  • If DIR were reflected at the POS, we estimate federal spending would increase by $24.4 billion for 2017 through 2026.
  • If DIR were reflected at the POS, we estimate beneficiary costs would decrease by $14.4 billion for 2017 through 2026. While some beneficiaries would experience lower cost sharing due to lower POS costs, all beneficiaries would pay higher premiums.
  • If DIR were reflected at the POS, we estimate pharmaceutical manufacturer coverage gap discount program (CGDP) payments would decrease by approximately $10.0 billion for 2016 through 2026.