CMS Finalizes Policies to Lower Prescription Drug Prices for Medicare Beneficiaries

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The Centers for Medicare & Medicaid Services (CMS) recently finalized policies for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices. 

The new policies include a reduction in the maximum amount that low-income beneficiaries pay for certain innovative medicines known as biosimilars.” According to the U.S. Food & Drug Administration, biosimilars are products that have no clinically meaningful differences from an existing FDA-approved product.

In an April statement, CMS Administrator Seema Verma said, The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs.”

The new policies include several other cost-saving measures, including:

  • Allowing for certain low-cost generic drugs to be substituted onto plan formularies at any point during the year, so beneficiaries immediately benefit and have lower cost sharing.
  • Increasing competition among plans by removing the requirement that certain Part D plans have to meaningfully differ” from each other, making more plan options available.
  • Increasing competition among pharmacies by clarifying the any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.

In addition, CMS announced new policies to combat opioid overprescribing and abuse, and to protect families and communities across the nation. For example, CMS is finalizing a new authority that permits Part D sponsors to require beneficiaries at risk of addiction or overuse to use only selected prescribers or pharmacies for opioid prescriptions.

More information on these, as well as additional policy changes to improve the quality of care, remove regulatory obstacles and empower patients to make more informed health care decisions, can be found in this CMS fact sheet.