Lexology May 10, 2022
Ropes & Gray LLP

On April 29, 2022, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule revising the way Medicare determines the “negotiated price” (i.e., the price upon which beneficiary cost-sharing is based at the pharmacy counter) under Medicare Part D.1 The final rule (the “2022 Final Rule”) revises the definition of “negotiated price” to mean the lowest possible reimbursement a network pharmacy will receive in total for a covered Part D drug.2 The 2022 Final Rule adopts this new definition of “negotiated price” across Part D, including the Coverage Gap Discount Program. As previewed and discussed at greater length in our January 18, 2022 alert discussing the proposed rule (“2022 Proposed Rule”),3 the 2022 Final Rule could likely have...

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Topics: Biotechnology, CMS, Govt Agencies, Insurance, Medicare, Patient / Consumer, Pharma, Pharma / Biotech, Provider
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