CMS proposes changes to prescription drug rules: 7 things to know

Becker's Healthcare November 27, 2018
Ayla Ellison

Here are seven things to know:

1. The proposed rule, which focuses on “protected classes” of drugs, provides Medicare Advantage and Part D plans more tools to negotiate lower drug prices.

2. Current policy requires Medicare Part D plans to cover drugs in the following six categories: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment of transplant rejection, antiretrovirals, and antineoplastics. The proposed rule would create exemptions to the “protected class” policy.

3. The proposed rule would allow Part D plans to implement broader use of step therapy and prior authorization, even within protected classes. The proposed rule would also allow Part D plans...

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