Specialty Tiers Ensure Part D Plans Cover High-Cost Biologics, Blum Says
This article was originally published in RPM Report
Executive Summary
CMS Medicare director Jonathan Blum acknowledges there is a “robust debate” within CMS regarding specialty tiers in Part D but says he believes permitting plans to charge beneficiaries higher cost-sharing for expensive biologics preserves access to such drugs.
You may also be interested in...
Specialty Drug Tier: When Special Means Expensive
Medicare led the way to create a policy that’s just plain mean. Is there any way back?
Mind Your Bs and Ds
There is a new variable to consider in drug development: which Medicare coverage system is more desirable: the Part B system for physician-administered drugs or Part D for the traditional retail market. But why choose one when you can play in both?
The $500 Threshold Under Medicare
The federal government is allowing Medicare prescription drug plans to make aggressive use of four-tier formularies. A key detail is the definition of products that qualify for the fourth "specialty" tier. CMS' rules will affect price negotiations for high cost drugs.