CMS Rolls Back Harmful Proposals in Medicare Part D

Last Thursday CMS finalized a rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, which included a number of significant changes to the proposed rule released last fall. The decision follows strong push back from the biopharmaceutical industry, the patient advocacy community and many Members of Congress.

Opponents of the rule were particularly concerned about a provision that would erode protections of the six protected classes by allowing Part D plans to implement broader use of prior authorization and step therapy for drugs in the protected classes and exclude a protected class drug from a formulary if the drug represents only a new formulation or if the price of the drug increased more than inflation.

The agency ultimately chose not to finalize this proposal, which would have severely limited access to needed medications for some of the most vulnerable patients.

The decision not to move forward with the problematic proposal is good news, but there is still more work to do to ensure that patients have access to right medicines at the right time and at costs they can afford. CBSA continues to work with our members and key stakeholders to educate our federal policymakers about barriers to patient access.

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