CMS Proposes Significant Changes to Medicare Advantage and Part D Prescription Drug Access

On November 26, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule that would make several changes to prescription drug services in the Medicare Advantage and Part D programs.  Proposals include: the creation of exceptions to the current requirement to provide all available drugs in six therapeutic categories, also referred to as protected classes; broader use of step therapy and prior authorization;  exclusion of a protected class drug if the price of the drug increases more than rate of inflation; and prohibiting pharmacy gag clauses for Part D prescription drug services.  The Proposed Rule also includes permitting step therapy for Part B drugs.

To read the press release accompanying the publication of the Proposed Rule, visit https://www.hhs.gov/blog/2018/11/26/proposed-changes-lower-drug-prices-medicare-advantage-part-d.html.   To access the full text of the Proposed Rule in the Federal Register, visit  https://www.federalregister.gov/documents/2018/11/30/2018-25945/modernizing-part-d-and-medicare-advantage-to-lower-drug-prices-and-reduce-out-of-pocket-expenses.

Comments on the Proposed Rule must be received not later than 5:00 p.m., EST, on January 25, 2019.

For questions about CMS pharmacy services policy, or for assistance in filing comments on the Proposed Rule, please contact Bill Stilling at bs@shhealthlaw.com.