The rule will allow members to know in advance and compare their out-of-pocket payments for different prescription drugs. CMS said the changes will result in an estimated $75.4 million in savings to the federal government over 10 years.
“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” said CMS Administrator Seema Verma in an announcement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”
Most provisions will be applicable to coverage that begins Jan. 1, 2022.
In an accompanying fact sheet, CMS said that the rule will also:
- Codify routine updates to the Star ratings under the Medicare Advantage and Part D Program Quality Rating System.
- Require Part D plans to disclose pharmacy performance measures to CMS, which will enable the agency to better understand how such measures are applied.
- Implement several provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that require Part D plans to educate beneficiaries on opioid risks, alternate pain treatments, and safe disposal of prescription drugs that are controlled substances, including opioids.
- Codify supplemental benefits, expanding the definition of “primarily health related” and the reinterpreted uniformity requirements, including that reduction in cost-sharing are an allowable supplemental benefit.
- Finalize provisions to reduce administrative burden for the Programs of All-Inclusive Care for the Elderly (PACE) organizations related to service determination requests.