CMS’ proposed rule would lower Medicare Advantage and Part D drug prices

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would provide Medicare Advantage and Part D plans more tools to negotiate lower drug prices. In addition, CMS is considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.

The proposal would also:

  • Provide Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes, so beneficiaries who need these drugs will see lower costs;
  • Require Part D plans to increase transparency and provide enrollees and their doctors with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written;
  • Codify a policy similar to the one implemented for 2019 to allow “step therapy” in Medicare Advantage for Part B drugs, encouraging access to high-value products including biosimilars; and
  • Implement a statutory requirement, recently signed by President Trump, that prohibits pharmacy gag clauses in Part D.

CMS will accept comments on the proposed rule through Jan. 25.