Fierce Health Payers February 12, 2020
The Trump administration gave Part D plans a new weapon to negotiate with drugmakers to get larger rebates, but with several caveats, experts say.
The Centers for Medicare & Medicaid Services (CMS) released a proposed payment rule for Medicare Advantage and Part D plans last week. The rule included a proposal to create a new preferred tier for Part D plans for specialty drugs in a bid to eventually lead to lower prices for seniors.
“CMS is hoping if plans have more flexibility and two potential tiers if it is deemed a specialty drug that will drive more competition and more rebates,” said Matt Kazan, a principal at consulting firm Avalere Health.
Currently, Part D plans put all specialty drugs,...
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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Payer, Pharma, Pricing / Spending, Provider