Medicare Part D Opioid Policies May Incorporate CDC Guidelines
This article was originally published in The Pink Sheet Daily
CMS notes some success in reducing the number of beneficiaries overusing opioids but proposes additional action for plans to manage access.
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Addiction prevention legislation empowers Medicare drug plans to restrict prescriber, pharmacy access to opioids for ‘at risk’ beneficiaries.
It’s not quite the rebate rule, but final reg aims for ‘a reduction in the use of rebates and other price concessions’ driven by the transparency requirement and broad definitions. PCMA warns that ‘mandating an increased level of disclosure for this information could result in higher prescription drug prices for consumers.’
Part of a broad rule that also aims to fix a coverage gap for COVID-19 vaccines, the payment policy differs from NTAP in that manufacturers of COVID therapies won’t have to formally apply and the add-on payments will not take the cost of the COVID products into account.