The Centers for Medicare and Medicaid Services has recently published a plan to decrease out-of-pocket expenses for prescription medication covered by Medicare Part D.
With a strong emphasis put on individuals having a dual Medicare-Medicaid coverage, the CMS also plans to facilitate improvement of the quality of care for those insured under commercial Medicare advantage plans. The proposed rule is to establish a policy that would require Part D benefit plans to apply all price concessions they receive from network pharmacies at the point of sale, which would decrease patients’ out-of-pocket responsibility. Price concessions are defined as agreements between pharmacies and insurance plans. According to such agreements, insurance may pay less money to pharmacies for distributed drugs if the pharmacies do not meet certain criteria defined by insurance payers. If this proposed rule is approved, patients will pay less in copays, deductibles, and coinsurance to pharmacy providers starting from January 1, 2023.
In addition, this proposed legislation focuses on the transparency of insurance payers. The CMS is planning to closely monitor the spending of Medicare Part D funds by various advantage plans.
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