CMS Releases Medicare Part C and Part D Proposed Rule

On November 26, the Centers for Medicare & Medicaid Services (CMS) announced proposed policies that continue to tackle drug pricing reform. Top-line takeaways from today’s proposals include:

• Proposed reform to Medicare Part D’s “protected” therapeutic classes.
• A new requirement in Medicare Part D to allow for increased transparency between patient and provider with provision of out-of-pocket cost obligations for prescription drugs whenever a prescription is written.
• A continued push to allow for and implement “step therapy” in Medicare Advantage plans for Part B drugs. The proposed rule also states the potential to infuse prior authorizations within this pool as well.
• Proposed implementation of a “statutory requirement” that would prohibit pharmacy gag clauses in Part D.

Read the CMS fact sheet on the proposed rule here.
Read the full proposed rule here.

The ACCC policy team is continuing to analyze this proposal. Stay tuned for more updates.