CMS Issues Proposed Changes to Medicare Advantage & Part D

On Feb. 5, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule and Advance Notice Part II.

The CY 2021/2022 Medicare Advantage and Part D Proposed Rule (CMS- 4190-P) would:

• require Part D plans to offer real-time drug price comparison tools to beneficiaries starting Jan. 1, 2022, to allow consumers to shop for lower-cost alternative therapies under their prescription drug benefit plan.

• allow a second, “preferred” specialty tier in Part D with a lower cost sharing amount.

• require Part D plans to disclose the measures they use to evaluate pharmacy performance in their network agreements. This would allow CMS to track and report publicly how plans are measuring and applying pharmacy performance measures.

In the Advance Notice, the agency asks for comments on potentially developing measures of generic and biosimilar utilization in Medicare Part D as part of a plan’s star rating.

Access a fact sheet on the CY 2021/2022 Medicare Advantage and Part D Proposed Rule (CMS- 4190-P).
Download the proposed rule.

Access a fact sheet on the 2021 Medicare Advantage and Part D Advance Notice Part II.

Download Medicare Advantage and Part D Advance Notice Part II.

Posted 2/6/2020