Part D drug proposal would bring real-time drug pricing to the office

by Richard Scott on Nov 27, 2018
Physicians may have a new tool at their disposal to find the lowest-priced drugs for patients should a proposed rule from CMS take effect as planned. The proposed rule, released Nov. 26, would require Part D plans to adopt a Real Time Benefit Tool that can alert providers to the current price of drugs available under a patient's coverage terms.
With the pricing tool and other proposals contained in the rule, CMS seeks to drive down the cost of pharmaceuticals and save patients millions in out-of-pocket costs, according to CMS Adminstrator Seema Verma, who commented on the rule upon its release. The agency also believes the option of attaining lower-cost alternatives can improve medication adherence rates by making patients more likely to stick to a prescribed regimen.
CMS also targets the protected class of drugs in the proposed rule, including antidepressants, immunosuppressants and antiretrovirals, among others. The agency seeks to provide plans with greater negotiating power, and it will allow payers to exclude protected drugs from their formularies should prices rise above a certain threshold. By setting limits on the protected class of drugs, CMS projects it will save the federal government $2 billion in spending over a decade and slash patients' spending by nearly $700 million.
The proposed rule, which would allow several additional exclusions that plans could take to keep high-cost drugs off of their formularies, follows in the Trump administration's ongoing efforts to curb pharmaceutical costs. The proposed changes would take effect in 2020.
How the exclusions shake out is worth watching because it could mean various commonly prescribed drugs disappear from patients' available benefit offerings. For more on the proposed rule, check out the CMS fact sheet here.
Blog Tags: CMS, proposed rules
The information contained herein was current as of the publication date. © Copyright DecisionHealth, all rights reserved. Electronic or print redistribution without prior written permission of DecisionHealth is strictly prohibited by federal copyright law.