CMS Promulgates Rule to Increase Transparency and Allow Flexibility

The Centers for Medicare and Medicaid Services has finalized a rule intended to make prices more transparent with Medicare Part D drug plans and allow plan sponsors to use cost-cutting tools such as step therapy under certain circumstances.

“CMS is delivering on price transparency, because patients have a right to know the cost of their healthcare services before they receive them,” CMS Administrator Seema Verma said in a statement Thursday afternoon.

Today’s rule requires Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket costs for prescription drugs at the time a prescription is written. By empowering patients with information on the cost of their prescription drugs, today’s rule will ensure that pharmaceutical companies have to compete on the basis of price. This effort builds on new requirements for hospitals to disclose chargemaster prices and other agency initiatives to promote price transparency.

Read the rule

Read Verma’s statement

For the six “protected” classes of drugs that each Part D plan is required to cover antidepressants; antipsychotics; anticonvulsants; immunosuppressants; antiretrovirals and antineoplastics. The rule also continues the current policy on step therapy, in which a health plan can require patients to try and fail a less expensive drug or therapy for a particular condition before being covered for a more expensive treatment.

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