国会预算办公室-2022年和解法案药物条款的影响：到目前为止我们学到了什么，还有什么问题？（英）

Presentation to CBO’s Panel of Health Advisers September 12, 2025Austin Barselau, Budget Analysis DivisionScott Laughery, Health Analysis DivisionEffects of the 2022 Reconciliation Act’s Drug Provisions: What Have We Learned So Far and What Questions Remain?1For the agency’s original cost estimate of the 2022 reconciliation act, see Congressional Budget Office, “Estimated Budgetary Effects of Public Law 117-169, to Provide for Reconciliation Pursuant to Title II of S. Con. Res. 14” (September 7, 2022), www.cbo.gov/publication/58455. ▪ Drug Price Negotiation. The secretary of Health and Human Services negotiates prices for certain prescription drugs covered under Medicare Part B and Part D. ▪ Inflation Rebate. Manufacturers of drugs covered under Medicare Part B and Part D must pay rebates to Medicare if the prices of brand-name drugs without generic or biosimilar competition exceed an inflation-adjusted benchmark. ▪ Part D Benefit Redesign. Enrollees’ annual out-of-pocket costs are capped and premium increases are temporarily limited; Part D plans’ share of costs beyond the out-of-pocket cap is increased; manufacturers are required to provide new mandatory price discounts. Major Drug Provisions of the 2022 Reconciliation Act 2For more discussion about the original estimate, see Congressional Budget Office, “How CBO Estimated the Budgetary Impact of Key Prescription Drug Provisions in the 2022 Reconciliation Act” (slide deck, February 2023), www.cbo.gov/publication/58850.CBO originally estimated that together, the three drug provisions of the 2022 reconciliation act would reduce the deficit by $129 billion through 2031. CBO has learned new information about the effects of the provisions. That information suggests that the agency probably overestimated the amount of savings from the act’s drug provisions, and the agency has subsequently changed its projections of the effects of those provisions.▪ Drug Price Negotiation: Price reductions for the first cohort of selected drugs were smaller than expected. CBO now projects smaller budgetary savings.▪ Inflation Rebate: General consumer price inflation was higher than expected after the coronavirus pandemic; that reduced the policy’s effect on drug prices and inflation rebate collections. CBO now projects smaller budgetary savings.▪ Part D Redesign: Plan bids for 2025 were higher than expected, in part because of changes in drug spending in 2023. CBO now projects greater outlays. Plan bids for 2026 were also higher than expected.Developments Since CBO’s Original Estimate and Their Expected Effects on Budgetary Savings3Congressional Budget Office, “A Call for New Research in the Area of New Drug Development,” CBO Blog (December 20, 2023), www.cbo.gov/publication/59818, and letter to the Honorable Jodey Arrington and the Honorable Michael C. Burgess providing additional information about drug price negotiation and CBO’s simulation model of drug development (December 21, 2023), www.cbo.gov/publication/59792