CMS NEWS
FOR IMMEDIATE RELEASE
April 2, 2018
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS lowers the cost of
prescription drugs for Medicare beneficiaries
Today, the Centers for Medicare & Medicaid Services (CMS) finalized
polices for Medicare health and drug plans for 2019 that will save Medicare
beneficiaries money on prescription drugs while offering additional plan
choices.
“The Trump Administration is taking steps for seniors with Medicare to
save money on prescription drugs,” said CMS Administrator Seema Verma. “The
steps we are taking will drive more competition among plans and pharmacies
to meet the needs of seniors and lower costs.”
The final policies announced today further the Trump Administration’s
commitment to lowering drug prices. CMS is finalizing a reduction in the
maximum amount that low-income beneficiaries pay for certain innovative
medicines known as “biosimilars.” Other actions that CMS is finalizing to
lower the cost of prescription drugs include:
- 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.
Today’s announcement builds on the work of the Trump Administration to
lower out-of-pocket drug prices. In Medicare, a rule implemented for 2018
will help beneficiaries save on coinsurance on Part B drugs administered at
hospitals that participate in the 340B program by reducing the amount Medicare
pays for those drugs. The 340B program allows hospitals to buy drugs at a
lower cost. Due to CMS’s policy change last year, Medicare beneficiaries
are currently benefiting from the discounts that 340B hospitals receive.
Beneficiaries are saving an estimated $320 million on out-of-pocket
payments for these drugs in 2018 alone. CMS is also providing new
information today to help hospitals implement this change, including how
this change applies for Medicare Advantage plans that provide Medicare
benefits through private insurance.
CMS is also finalizing policies that respond to the President’s call to
end the scourge of the opioid epidemic. These policies provide Medicare
with additional tools 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.
As part of today’s announcement and guidance, the agency is
reinterpreting the standards for health-related supplemental benefits in
the Medicare Advantage program to include additional services that increase
health and improve quality of life, including coverage of non-skilled
in-home supports and other assistive devices. CMS is expanding the
definition of “primarily health related.” Under the new definition, the
agency will allow supplemental benefits if they compensate for physical
impairments, diminish the impact of injuries or health conditions, and/or
reduce avoidable emergency room utilization.
The final policies also advance the “Patients Over Paperwork” initiative
– an effort aimed at removing regulatory obstacles and empowering patients
to make informed healthcare decisions; developing innovative approaches to
improving quality, accessibility, and affordability; and improving
beneficiaries’ customer experience. Specifically, the final policies will:
- Authorize CMS to
permit plans to use notice of electronic posting (and provision of
copies upon request) to satisfy disclosure requirements for certain
bulky documents to Medicare beneficiaries.
- Improve transparency
of the Star Ratings that give beneficiaries information about each
Medicare Advantage and Part D plan’s quality rating. The changes put
patients first by increasing the weight given to patient experience
and access measures.
- Streamline
government review and approval of marketing materials Medicare health
and drug plan use.
For a fact sheet on the 2019 Rate Announcement and Final Call Letter,
please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html.
For a fact sheet on the final rule (CMS-4182-F), please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02.html.
The 2019 Rate Announcement and Call Letter may viewed through: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html
by selecting “2019 Announcement.” The final rule can be downloaded from
CMS.gov at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/CY2019-Medicare-Advantage-Part-D-Final-Rule.pdf.
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