More pricing transparency for seniors on Medicare

The Centers for Medicare & Medicaid Services (CMS), a United States Department of Health and Human Services federal agency, has modernized their Medicare Advantage and Medicare Part D programs to improve the costs and transparency concerning prescription drug prices.

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Jun 05, 2019

The Trump administration has passed legislation to improve the current Centers for Medicare & Medicaid Services (CMS) Medicare Advantage and Medicare Part D programs. These deliver medical and prescription drug coverage to seniors via competing private insurance plans.

Changes to Medicare Advantage and Medicare Part D aim to provide patients with greater knowledge of their prescription drug costs. This transparency will give patients more complete knowledge of their treatment options and a source for negotiating with pharmaceutical companies for better value care.

Alex Azar, United States Secretary of Health and Human Services Secretary, commented that these changes “…are significant steps toward a Medicare program, a drug pricing marketplace, and a healthcare system where the patient is at the center and in control.”

Under the policy, it will be required for clinicians to have access to information on a variety of prescription drug prices, at the time they are physically prescribing. The CMS hopes that this early-stage transparency on patient’s personally supplemented costs for their prescription drugs will promote patient autonomy, empowerment and strengthen clinician—patient relationships.

Transparency also helps ensure pharmaceutical companies will now be competing on drug cost only; this supports requirements for hospitals to be upfront concerning chargemaster prices and other initiatives for increasing price transparency.

The amendments also require the Explanation of Benefits document that all Part D enrollees receive monthly to include information on drug price increases and lower-cost alternatives. This not only further promotes transparency but may also the likelihood of patient therapy adherence as they can understand and seek out specific options.

Further, new Part D rules promote pharmacists’ disclosure of other, cheaper means for patients to get prescription medication. This opposes so-called “gag clauses” that can prevent this. This also complements recent plans announced by the CMS to force pharmaceutical companies to reveal the list prices of prescription drugs in television advertisements.

Additionally, the CMS is working towards further changes that will make physician-administered therapies more affordable.

The agency also proposed facilitating negotiations for price reductions of drugs in Part D’s “protected” classes, although this has not been finalized.

These actions highlight the concerns of the CMS about the significantly reduced discounts offered by pharmaceutical companies to seniors in Medicare for protected class drugs than are currently offered in the commercial market.

In the interim, the agreed changes contribute to the ongoing effort made by the agency to lower prescription drug costs and improve transparency.


Go to the profile of Ilana Landau

Ilana Landau

Assistant Editor, Future Science Group

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