Class Warfare: CMS Proposes Sweeping Changes to Part D; “Protected Class” Cuts Just the Start
This article was originally published in RPM Report
The Centers for Medicare & Medicaid Services is celebrating the 10th anniversary of Part D by proposing the most sweeping changes to the Medicare drug benefit since it launched. Proposed revisions to the “Protected Classes” will get the most attention, but the rest of the rule may have more profound impacts going forward.
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CMS is getting around to some unfinished business by finalizing some changes to the Medicare Advantage and Part D Drug benefit programs first laid out in a January 2014 draft proposal. The agency, however, is not trying to reopen the controversy that proposed rule set off.
CMS’ final rule on Part D is much narrower than the agency’s proposed rule—and most in industry are probably pleased by that. But it is also much more one-sided, emphasizing new tools to monitor for and correct “abusive” prescribing, without any countervailing provisions reflecting the value of appropriate medication adherence.
CMS dropped the most controversial provisions from a proposed rule to overhaul Medicare Part D in the face of united opposition from the pharmaceutical industry, health plans, and patient advocacy groups. Now community pharmacy is pushing to restore one of those provisions via legislation.