CMS Issues Proposed Rule to Lower Drug Costs

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would amend Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations “to support health and drug plans’ negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees.” Current Part D policy requires sponsors to include in their formularies all drugs in six categories or classes: 1) antidepressants; 2) antipsychotics; 3) anticonvulsants; 4) immunosuppressants for treatment of transplant rejection; 5) antiretrovirals; and 6) antineoplastics; except in limited circumstances. The proposed regulatory provision maintains all six protected classes; however, the proposal would provide Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes, so beneficiaries who need these drugs will see lower costs. For more details, see today’s Financial Feature.

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