Budget Proposals Have Myriad Effects on the Industry Source: Retrieved from: https://www.appropriations.senate.gov/imo/media/doc/Bipartisan%20Budget%20Act%20of%202018.pdf, accessed February 2018; Health Strategies Group, Value, Quality, and Reimbursement, and Insurance Benefit Design, February 2018. Medicare POS rebates pass-through Test eliminating Medicaid best price Medicare biosimilar discount Part B payment changes Medicare catastrophic limits Expanded MA benefits Level of Impact Effect on Business Low Medium High + – Neg Pos Star ratings adjustment IPAB repeal Medicaid line extension penalty Part D formulary narrowing New Medicare drug price reporting rules Faster Medicare coverage gap fill Medicare Part B to D shifts