Size Of Drug Discounts In Part D Employer-Sponsored Plans At Stake In Debate Over CMS Proposal
The biopharmaceutical industry is fighting a CMS proposal that would impact the size of manufacturer discounts on drugs provided in the Medicare Part D coverage gap in an emerging type of Part D coverage for retirees – employer-sponsored group waiver plans, known as EGWPs.
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The Pharmaceutical Research and Manufacturers of America, as well as pharmacy and PBM groups, recommend that CMS test its proposed policy to institute trial-size prescriptions before implementing it on a widespread basis to Medicare Part D.
CMS’ proposal to reduce overprescribing in nursing homes draws cautiously favorable response from national pharmacist group, but long-term care pharmacy firm Omnicare argues the agency has not provided adequate justification for its plan.
If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.