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Reference-Based Pricing In Part D Prompts Transparency Concerns

Executive Summary

CMS is working on improving transparency in the use of reference-based pricing by Medicare Part D plans and what that means for beneficiaries, the agency says

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The last CMS 1draft "call letter" to Medicare Part D contractors to be issued under the current administration emphasizes familiar themes - concern with information transparency and ensuring appropriate access to drugs - and includes little in the way of drug coverage policy changes

Part D In 2010: No Reference Pricing, More CMS Scrutiny Of Formulary Edits

The last CMS 1draft "call letter" to Medicare Part D contractors to be issued under the current administration emphasizes familiar themes - concern with information transparency and ensuring appropriate access to drugs - and includes little in the way of drug coverage policy changes

Reference-based pricing in Part D

Beginning Dec. 23, CMS will add a footnote to more places in its Medicare Part D Plan Finder Web site alerting users that reference-based pricing may apply to the cost of certain brands, a spokesman said. Approximately 10 percent of the 2009 Part D contracts use the reference-based pricing, according to the agency. Reference-based pricing in Part D involves the requirement that, on top of a co-pay, members must pay an additional charge if they choose a brand-name drug when its generic equivalent is available 1("The Pink Sheet," Dec. 8, 2008, p. 21). AARP wrote to CMS Dec. 16 requesting changes to Plan Finder to ensure greater transparency on the practice and that beneficiaries who enrolled based on "misleading" information in Plan Finder be permitted to switch plans beyond the Dec. 31 enrollment deadline

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