CMS News Center

CMS Lowers Prescription Drug Costs for Medicare Beneficiaries 

The Centers for Medicare & Medicaid Services (CMS) recently finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices, officials said. 

“The Trump Administration is taking steps for seniors with Medicare to save money on prescription drugs,” said Seema Verma, CMS administrator, in a prepared statement. “The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs.” The final policies further the Trump administration’s commitment to lowering drug prices. CMS is finalizing a reduction in the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.” Other actions that CMS is finalizing to lower the cost of prescription drugs include:

• Allowing for certain low-cost generic drugs to be substituted onto plan formularies at any point during the year so that beneficiaries immediately benefit and have lower cost sharing.
• Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.
• Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.

In Medicare, a rule implemented for 2018 will help beneficiaries save on coinsurance on Part B drugs administered at hospitals that participate in the 340B program by reducing the amount Medicare pays for those drugs, officials said. The 340B program allows hospitals to buy drugs at a lower cost. Due to CMS’ policy change last year, Medicare beneficiaries are currently benefiting from the discounts that 340B hospitals receive. Beneficiaries are saving an estimated $320 million on out-of-pocket payments for these drugs in 2018 alone. CMS is also providing new information to help hospitals implement this change, including how this change applies for Medicare Advantage plans that provide Medicare benefits through private insurance. CMS is also reportedly finalizing policies that respond to Trump’s call to end the scourge of the opioid epidemic. These policies provide Medicare with additional tools to combat opioid overprescribing and abuse, and to protect families and communities across the nation, officials said. For example, CMS is finalizing a new authority that permits Part D sponsors to require beneficiaries at risk of addiction or overuse to use only selected prescribers or pharmacies for opioid prescriptions. Visit www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2018-fact-sheets-items/2018-04-02-2.htmlfor more information. 

CMS Proposes Regulation to Alleviate State Burden

Officials at the Centers for Medicare & Medicaid Services (CMS) have issued a notice of proposed rulemaking (NPRM) that would provide state flexibility from certain regulatory access to care requirements within the Medicaid program. Specifically, the NPRM would exempt states from requirements to analyze certain data and monitor access when the vast majority of their covered lives receive services through managed care plans, officials said. Additionally, the NPRM would provide similar flexibility to all states when they make nominal rate reductions to fee-for-service (FFS) payment rates. States have raised concerns over undue administrative burden associated with meeting the requirements of the final rule on methods for assuring access to covered Medicaid services published in November 2015. Specifically, states with few Medicaid members enrolled in their FFS program or when members are only temporarily enrolled, and states making small reductions to FFS payment rates have urged CMS to consider whether analyzing data and monitoring access in that program is a beneficial use of state resources. To respond to these concerns, the NPRM proposes the following changes:

• States with an overall Medicaid managed care penetration rate of ≥ 85% (currently, 17 states) would be exempt from most access monitoring requirements.
• Reductions to provider payments of < 4% in overall service category spending during a state fiscal year (and 6% over two consecutive years) would not be subject to the specific access analysis.
• When states reduce Medicaid payment rates they would rely on baseline information regarding access under current payment rates, rather than be required to predict the effects of rate reductions on access to care, which states have found very difficult to do.

Visit www.medicaid.gov/medicaid/access-to-care/index.htmlfor more information.