CMS Proposes Medicare Advantage and Part D Changes to Improve Transparency

As part of President Trump’s executive order Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health, the Centers for Medicare & Medicaid  (CMS) proposed changes to Medicare Advantage and Part D.

The goal of these proposed changes would be to “lower beneficiary cost sharing on some of the most expensive prescription drugs, promote the use of generic drugs, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs,” according to CMS’ press release.

The proposed changes would require Part D plans to provide real-time drug price comparison tools beginning January 1, 2022. This tool will be available for patients to compare copays for doctor-recommended prescriptions to potential generics or other cost-saving options in an effort to save patients’ money. CMS notes that this tool could also increase cost competition for pharmaceutical companies.

“Whether you’re a senior dealing with kidney disease, living in a rural area, facing high costs because you need a specialty drug, or just want a better sense of what you’ll owe for prescription drugs, these new CMS proposals will improve your Medicare experience,” said US Department of Health and Human Services Secretary Alex Azar.

“In addition to giving those with kidney disease more choices, today’s proposals shed desperately needed light on previously obscured out-of-pocket costs for prescription drugs,” said CMS Administrator Seema Verma.

The changes would also create a second “preferred” specialty tier in Part D to lower cost sharing amounts between beneficiaries. Currently, “all drugs on a plan’s specialty tier—the tier that has the highest-cost drugs—have the same level of cost sharing,” said CMS in the press release. By adding the second tier, CMS and the Trump administration hope Part D beneficiaries will have reduced out-of-pocket costs.

Other proposed changes include requiring Part D plans to disclose their pharmacy performance measures so that CMS can better track and share results, increased use of generics, lifting limitations that prevent patients with end-stage renal disease from enrolling in Medicare Advantage, and adding more telehealth options under Medicare fee-for-service coverage. It also mentions parameters to address the opioid epidemic by offering increased education and support for patients through medication therapy management and intervention programs.

CMS is accepting public comments on all the proposals through Friday, March 6, 2020 via www.regulations.gov. —Edan Stanley