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   To access the full text of the Proposed Rule in the Federal Register, visit

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 [email protected].