![]() This post originally appeared in Inside Health Policy on May 16, 2019. Two consecutive administrations have failed to follow through with proposals to weaken Medicare Part D coverage protections in six drug classes. CMS again scrapped the idea in a final Part D rule it issued Thursday (May 16). When it proposed the rule last November, the agency had called for letting Part D plans exclude drugs in protected classes from formularies when their makers raise prices faster than inflation or when drug companies make new formulations of drugs already on the market. The proposed rule also called for allowing Part D plans to more broadly use step therapy and prior authorization for protected class drugs. However, CMS backed off all changes to the protected classes.
“This rule cements Medicare’s protected classes policy as an essential patient safeguard in Medicare’s prescription drug program,” said Chuck Ingoglia, executive director of the Partnership for Part D Access. Patient groups had lobbied hard against the proposal and heaped praise on the administration for backing down. A bipartisan group of more than 70 House lawmakers also urged CMS to withdraw the proposal. However, CMS kept a separate step therapy policy it proposed. The final rule lets Medicare Advantage plans use step therapy for Part B drugs. One of the main goals of that policy is to let plans require that patients try biosimilars before branded reference biologics. Insurers may only impose step therapy on patients who are starting on a medication. Pharmacy benefit managers are pleased CMS did not change the treatment of pharmacy price concessions. CMS informally proposed subtracting fees that PBMs charge pharmacies from prices that seniors pay when they pick up drugs at the pharmacy. Pharmacists lobbied White House budget officials in the lead up to the final rule’s release to argue for including the informally proposed changes in the final rule. However, the agency didn’t back off the pharmacy price concessions proposal, on which it received more than 4,000 comments. “CMS will continue to carefully review these comments as we continue to consider policies that would lower prescription drug costs, address challenges that independent pharmacies face, and improve the quality of pharmacy care,” a CMS fact sheet states. The final rule will require Part D plans to inform members on their explanation of benefits of drug price increases and cheaper therapeutically equivalent drugs, starting 2021. The rule also implements a new law that prohibits pharmacy gag clauses in Part D.
5 Comments
Antumn Bates
7/10/2024 02:56:43 pm
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Hailey Garcia
6/8/2024 09:53:15 am
My name is Hailey Garcia and I am from New Jersey. My herpes virus turned to war after 2 years of living with it. I have tried different medical procedures to cure my herpes but to no avail. Most people think herpes is only a minor skin irritation of which herpes has long term effects on health and passes through the bloodstream and can be easily contracted through sexual intercourse. I knew I had herpes from the first day I started feeling itchy in my pubic area and the pain was very unbearable. I couldn't stand it anymore. After 2 years of trying other means to get rid of it, I had to contact Doctor Odunga to help me with a permanent cure. I saw his email and whats-app number from a testimony I read online from a lady who was also helped by him in curing infertility problems, I had faith and contacted him. He assured me of his work and I ordered his herbal medicine. Within 5 days, I didn't feel any pain anymore and within 2 weeks, my skin was all cleared and smooth. I am very grateful to you sir and I write this testimony as others have done to bring those having faith to you sir. If you have herpes or other similar disease and you want it cured, kindly contact Doctor Odunga, Whats-App (wa.me/+2348167159012) OR Email [email protected]
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SHAW
6/21/2024 05:19:13 pm
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Antumn Bates
7/10/2024 02:56:11 pm
Does anyone still doubt natural herbs? I've seen the great importance of natural herbs and the wonderful work it has done in people's lives. Natural herbs can cure all kinds of illnesses including herpes-1&2, diabetes, HIV, hepatitis, HPV, cancer, Vaginal infection etc. I've seen it with my own eyes. I was cured from Herpes and HPV and my friend got cured from herpes too. We all got the herbs from Dr. Osato. Dr Osato uses natural herbs to cure different kinds of diseases/viruses. Even Dr. Sebi proved to the world that natural herbs can cure all illnesses and he cured countless people using herbs. I know it is hard to believe but I am a living testimony. I was diagnosed with Herpes and HPV in 2020 and I believe there is a cure even when the doctors said there is no cure yet. I strongly believe in herbs and i came across a comment on a blog written by Cresia Sutherland saying she was cure from HERPES by Dr Osato and i quickly contact Dr Osato on the email that was provided on the comment and order one for myself and he sent it to me through UPS and gave me instructions on how to use it and after i finish taken it i went for a checkup and the result shows am HERPES and HPV NEGATIVE. I waited for 3months to confirm my result before writing this testimony and every month I would go and retest and all my results were NEGATIVE. My doctor said that the virus is completely gone from my body. There is no harm in trying herbs, it works perfectly and it has no side effects. You can contact Dr Osato by email to get yours.. His email is [email protected] or WhatsApp him on +2347051705853. His website is osatoherbalcure.wordpress.com I will continue to publish this in every blog so people can know that there is a cure for HERPES, HPV and other diseases/viruses. Stop living in anguish and let us eradicate this virus out of this world. Dr Osato is the man with the right herbal medicine for your illness.
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