CMS Proposes Rule to Lower Costs for Medicare Part D Prescriptions

With the new year come new rule proposals from the Centers for Medicare & Medicaid Services (CMS), which this week proposed updates to the Medicare Advantage (MA) and Part D programs that could reduce out-of-pocket costs, as well as improve experiences for dually eligible enrollees and more.

“We are dedicated to ensuring older Americans and those with disabilities who are served by the Medicare program have access to quality, affordable health care, including prescription drugs and therapies,” said CMS Administrator Chiquita Brooks-LaSure.

The newly proposed rule is partially based on feedback from late 2018 on a policy that requires Part D plans to apply price concessions—the arrangement in which plans pay discounted rates to pharmacies that do not meet certain metrics. CMS noted these concessions lack public visibility and the pricing is not share with the beneficiaries. After receiving comments, CMS proposes that come January 1, 2023, Part D plans be required to apply all price concessions received from network pharmacies at the point of sale. The goal is to increase transparency, as well as encourage market competition.

“In addition, CMS is proposing actions that reduce health disparities by ensuring that all MA special needs plans solicit information about an individual’s barriers to accessing care, through standardized questions in required health risk assessments on housing instability, food insecurity, and transportation,” said CMS in the press release.

In an effort to further protect those with Medicare, CMS proposed increased oversight of third-party marketing organizations that disseminate information on behalf of MA organizations and Part D sponsors, as well as requiring plans to communicate the availability of free translations services.

Other proposed updates under the new rule include:

• Limiting MA plans’ ability to expand or enter into new contracts if previous performance is poor
• Requiring MA and Part D plans to provide more extensive reports on how revenue is spent

Lastly, CMS is seeking to better understand access barriers to behavioral health care and is requesting feedback on challenges within provider networks and the potential impact of CMS policy changes.

Reference:
Centers for Medicare & Medicaid Services. CMS takes action to lower out of pocket Medicare Part D prescription drug costs. January 6, 2022. Accessed January 7, 2022. https://www.cms.gov/newsroom/press-releases/cms-takes-action-lower-out-pocket-medicare-part-d-prescription-drug-costs