August 8, 2018

CMS ‘Puts Patients First’ in New Medicare Rule

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August 7th, 2018 marks the day the Centers for Medicare & Medicaid Services (CMS) delivered on President Trump’s promise to negotiate better deals for Medicare patients with lowered drug prices.

This action gives Medicare Advantage plans the option of applying step therapy (trying less expensive options before “stepping up” to drugs that cost more) for physician-administered and other Part B drugs. The new measure would reportedly create 15% to 20% discounts and require more than half of the savings to be passed on to senior citizens.

“For the first time, CMS will provide Medicare Advantage plans — private health insurance plans that provide Medicare benefits to 20 million Medicare beneficiaries (a third of all beneficiaries in Medicare) — the option of negotiating for Part B drugs in a way that lowers costs and improves the quality of care,” CMS said in a statement.

MA plans will not be required to implement step therapy, but those that decide to do so must inform beneficiaries before the next enrollment period in October.

CMS Administrator Seema Verma also said she expects lower drug prices to come from insurers and pharmacy benefit managers negotiating better discounts and passing those savings on to patients.

“Today we begin lifting those barriers, so plans can use private-sector tools to drive down the cost of expensive drugs while also offering new care coordination and drug adherence programs, to ensure that patients are getting high-quality care at lower cost.”

The Pharmaceutical Care Management Association (PCMA) added: “to include greater use of PBM tools in Medicare Part B through Medicare Advantage Prescription Drug Plans is an important step toward reducing costs for the program and beneficiaries.”

Plans can implement the changes starting January 1st, 2019.

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