Sweeping changes to Medicare prescription drug costs, availability in the works under proposed rule

Stock image, St. George News

DISTRICT OF COLUMBIA — The Centers for Medicare & Medicaid Services issued a proposed rule Thursday that includes a number of changes.

If finalized, the rule will ensure that Part D Medicare enrollees have access to more affordable prescription drugs and more robust prescription drug coverage at the pharmacy they prefer. The rule also gives health plans a new tool to combat the opioid crisis.

President Trump has been committed to lowering drug prices for seniors and fighting the opioid epidemic, according to a press release from the Centers for Medicare & Medicaid Services. In response, CMS is working to lower drug prices by removing administrative hurdles to offer lower cost options to seniors on Medicare, as well as supporting private sector partners by providing them a much needed tool in the fight to end the opioid epidemic.

CMS is proposing to lower drug costs by providing flexibility for certain midyear changes to prescription drug formularies when a new generic drug becomes available and is clinically appropriate, while protecting beneficiaries who require the brand name drug. This change will provide flexibility to switch to lower cost prescription drugs and pass those savings on to Medicare beneficiaries.

CMS is also proposing to lower drug costs by treating lower-cost “biosimilar” versions of biologic products like other generic drugs when determining how much certain beneficiaries pay for drugs out of pocket under Medicare Part D. This change will encourage the availability of lower-cost alternatives for Medicare beneficiaries.

The proposed rule also includes a “Request for Information” on applying discounts drug companies provide to health plans to the price beneficiaries pay at the pharmacy counter. CMS is requesting input on whether this idea would maximize cost-sharing savings for beneficiaries, how they might best be implemented and what the implications would be for various stakeholders and taxpayers.

CMS is also empowering beneficiaries to access their prescription drugs at the pharmacy they prefer. CMS is proposing to revise the pharmacy participation rules in Part D which will promote greater participation of local pharmacies in Part D and preserve beneficiary access to all types of pharmacy delivery services, including mail-order.

To help address the national health crisis created by opioid abuse, CMS is proposing to implement new authority that allows Part D plans to require certain beneficiaries to obtain their prescriptions for opioids from selected prescribers or pharmacies. The proposal would provide an important new tool to combat the growing opioid epidemic that is devastating families and communities across the nation.

For a fact sheet on the proposed rule, please visit the CMS Proposed Policy Changes and Updates webpage.

The proposed rule (CMS-4182-P) can be downloaded from the Federal Register.

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  • commonsense November 18, 2017 at 9:15 pm

    I take a drug which has been around for 30 years and is generic but only one drug company makes so it’s very expensive even though cheap to manufacture. This has got to be addressed.

  • high5 November 19, 2017 at 8:51 am

    I use one – they call a drug, it’s been around for thousands of yrs
    No Perscrption needed.
    Always works. No Dr.

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