CHA News Article

Proposed Rule Would Reduce Medicare Part D Drug Prices
Comments due Jan. 25

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule intended to provide Medicare Advantage and Part D plans with more tools to negotiate lower drug prices. The agency also issued a fact sheet about the rule.

Among the proposed changes, CMS would provide Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes; require Part D plans to 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; and implement a statutory requirement that prohibits pharmacy gag clauses in Part D. In addition, CMS seeks comment on a policy under consideration for a future plan year that would that would require pharmacy rebates to be passed on to beneficiaries.

CHA is currently reviewing the proposed rule and its implications for hospitals and patients. Comments on the proposed rule are due Jan. 25.

Commands