The Centers for Medicare & Medicaid Services (CMS) Friday issued a final rule that aims to advance the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. Most of the changes are effective for the 2022 plan year and could lower enrollee cost sharing on some of the most expensive prescription drugs.
The rule will allow members to know in advance and compare their out-of-pocket payments for different prescription drugs. CMS said the changes will result in an estimated $75.4 million in savings to the federal government over 10 years.
“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” said CMS Administrator Seema Verma in an announcement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”
Most provisions will be applicable to coverage that begins Jan. 1, 2022.
In an accompanying fact sheet, CMS said that the rule will also:
- Codify routine updates to the Star ratings under the Medicare Advantage and Part D Program Quality Rating System.
- Require Part D plans to disclose pharmacy performance measures to CMS, which will enable the agency to better understand how such measures are applied.
- Implement several provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that require Part D plans to educate beneficiaries on opioid risks, alternate pain treatments, and safe disposal of prescription drugs that are controlled substances, including opioids.
- Codify supplemental benefits, expanding the definition of “primarily health related” and the reinterpreted uniformity requirements, including that reduction in cost-sharing are an allowable supplemental benefit.
- Finalize provisions to reduce administrative burden for the Programs of All-Inclusive Care for the Elderly (PACE) organizations related to service determination requests.