Bill Overview
Title: Mandating Exclusive Review of Individual Treatments (MERIT) Act
Description: This bill specifies that coverage determinations for drugs and biologics under Medicare must be made with respect to each drug or biologic, rather than with respect to a class of drugs or biologics.
Sponsors: Rep. Buchanan, Vern [R-FL-16]
Target Audience
Population: Medicare beneficiaries using drugs or biologics
Estimated Size: 64000000
- The bill affects how coverage determinations for drugs and biologics are made under Medicare.
- Medicare primarily serves U.S. citizens who are aged 65 and older, younger people with disabilities, and people with End Stage Renal Disease.
- This group includes a significant portion of the elderly population in the United States.
- Coverage determinations for individual drugs or biologics may impact treatment options for individuals relying on Medicare.
- In 2022, over 63 million people were enrolled in Medicare.
Reasoning
- The target population predominantly includes older adults aged 65 and above, and individuals with disabilities, who are reliant on Medicare for their drug and biologic treatment coverage.
- Medicare is a specific U.S. federal program, which means the policy will not affect those outside this demographic.
- The policy's impact will vary depending on individual needs for specific drugs or biologics, with potential improvements in personalized treatment options for some.
- We expect a range of impacts, from none if someone relies on class-based generic drugs, to high if someone is dependent on a specific high-cost drug which may become more accessible.
Simulated Interviews
Retired (Tampa, FL)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I often worry about whether the medications I need will remain affordable.
- The personalized review seems like it will help me get better care specific to my needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Farmer (Des Moines, IA)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- It's good they are focusing on individual drugs because my treatment depends on specific biologics.
- Having more personalized evaluations might mean I get exactly what is best for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 8 | 4 |
Retired Teacher (Phoenix, AZ)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 7.0 years
Commonness: 10/20
Statement of Opinion:
- I am happy to see there might be more attention to individual drugs.
- However, I hope this doesn't complicate things and make them more expensive.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
Musician (New York, NY)
Age: 64 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 12/20
Statement of Opinion:
- I might see benefits later when I join Medicare.
- The impact on individual drugs is something I look forward to as it could make treatments more tailored.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Retired Civil Engineer (Seattle, WA)
Age: 78 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 6.0 years
Commonness: 7/20
Statement of Opinion:
- The individual consideration can help me get the best heart medicine available, which is great.
- I hope that it will also lower my out-of-pocket expenses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Retired Accountant (Austin, TX)
Age: 66 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- The MERIT Act could significantly enhance my access to the specific drugs I need.
- I feel hopeful that this could simplify getting coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 9 | 3 |
| Year 20 | 8 | 3 |
Volunteer (Boise, ID)
Age: 74 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- I already have a personalized plan so I don't think this will make much difference.
- It's a decent effort to improve things for others though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired Fisherman (Charleston, SC)
Age: 80 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 11/20
Statement of Opinion:
- I'm skeptical about how much it will help—the changes could create confusion.
- Hope it won't affect my current access to essential drugs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Part-time Consultant (Los Angeles, CA)
Age: 69 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- Hopefully, these detailed reviews mean I'll get the best medication possible.
- It sounds promising but we need to be aware of potential costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired Factory Worker (Detroit, MI)
Age: 81 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I'm not sure how this will change anything for me.
- If it leads to better bargains on medications, I'll be glad.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $1500000000 (Low: $1000000000, High: $2000000000)
Year 2: $1575000000 (Low: $1050000000, High: $2100000000)
Year 3: $1653750000 (Low: $1102500000, High: $2205000000)
Year 5: $1825206250 (Low: $1216800000, High: $2433600000)
Year 10: $2250955334 (Low: $1557000000, High: $3114000000)
Year 100: $10000000000 (Low: $7000000000, High: $14000000000)
Key Considerations
- The complexity of implementing individual drug evaluations under existing Medicare systems.
- Potential lobbying by pharmaceutical firms who could be affected negatively depending on coverage outcomes.
- Need for enhancement of Medicare decision-making infrastructure to handle increased workloads effectively.
- The overarching impact on healthcare recipients, specifically regarding access to potentially life-saving drugs.