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Medicare Enrollees Could See Savings From Proposed Program Changes

Tuesday, April 3, 2018  
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Lower prescription costs for Medicare enrollees are promised under policies announced this week by the Centers for Medicare & Medicaid Services (CMS).

As part of an ongoing effort to reduce prescription drug costs, CMS said it is finalizing a plan to lower the price low-income beneficiaries pay for medicines referred to as biosimilars.

The proposed lower costs, which were among a handful of other initiatives announced Monday, are expected to result in a $10 million program savings in 2019, according to a CMS release. Proposed changes are set to go into effect Jan. 1.

Another finalized policy allows for certain generic drugs to be substituted onto plan formularies at any point in the year, allowing beneficiaries to access lower-cost options sooner. Currently, Medicare beneficiaries must wait until the next open enrollment period before they can use their insurance for newly approved prescription drugs.

CMS said other proposals seek to increase competition among plans and pharmacies by removing a requirement that certain Medicare Part D plans have to “meaningfully differ” from each other and clarifying an “any willing provider” requirement.

The latter update could increase the number of pharmacy options available to beneficiaries, according to administrators.

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

The agency this week also issued 2019 rates and a final rule on Medicare Advantage and Part D updates. It estimates the rule will result in $295 million in annual savings for the Medicare program over the next five years.

CMS said it will also provide Medicare with additional tools to combat opioid addictions and overprescribing. Among them is new authority for Part D sponsors to require beneficiaries at risk of addiction to use only certain prescribers or pharmacies for opioid prescriptions.

Proposals this week didn’t include plans for an overhaul of Medicare rebates, which lawmakers and the administration have questioned in recent months. Benefit managers and Part D insurers presently receive discounts on certain prescription drugs and collect fees. They are not required to pass that money on in the form of consumer savings.

Administrators said CMS has received detailed stakeholder input on the issue and it is being evaluated as the agency considers future policies.