When CMS issued the final
rule on Medicare Advantage and Part D drug pricing on May 16, the agency touted
its policy changes as ensuring consumers get greater transparency into the cost
of Part D prescription drugs and enabling MA plans to negotiate better prices
for physician-administered medicines in Part C. Yet, after receiving 4,000-plus
comments related to pharmacy price concessions on negotiated price, CMS held
back, saying it won't implement this policy for 2020 — or follow through on
proposed exceptions to Part D protected drug classes.
Among numerous
provisions, CMS's final rule implements the statutory prohibition against gag
clauses in pharmacy contracts, barring Part D plans from penalizing pharmacies
that disclose a lower cash price to enrollees. But the agency decided against
implementing a policy redefining negotiated price as the lowest possible,
baseline payment to pharmacies.
Leerink analyst Ana Gupte
sees industry winners across the board. CMS "did not follow through on its
proposal to exclude certain protected drug classes, offering a win for the
biopharma industry," she said in a May 17 note. "Managed Care and
PBMs also garnered a win as CMS did not follow through on the proposals to pass
through pharmacy pricing concessions in the form of DIR [direct and indirect
remuneration] fees to patients through reduced cost sharing."
Dea Belazi, Pharm.D.,
president and CEO of AscellaHealth, offers a blunter assessment. "I think
the final Part D rule is more rhetoric than anything," he tells AIS Health.
As for negotiated price,
"They're not ready to do anything on pricing at this point," Belazi
says. "I think CMS, with HHS, opened up a Pandora's box and realized this
is not as easy as it seems and they need more time."
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