The Center for Medicare Services (CMS) is working on a new proposal that would significantly lower out-of-pocket prescription costs and enhance consumer protections in Medicare Advantage (MA) and Part D plans.
The proposed plan would update the MA and Medicare Part D rules, regarding discounts for pharmacy pricing that would reduce out-of-pocket expenses for beneficiaries. While the provisions may allow Medicare to lower out-of-pocket drug costs, CMS estimates the minor expenses connected with regulations in the proposal, will not significantly altar MA plans, supplemental benefits, or monthly premiums.
How Medicare will Lower Part D Drug Costs
Many drug plans enter partnerships with pharmacies, so they may pay less for dispensed medicines. The negotiated price, however; is frequently greater than the payment the pharmacy’s receive. Medicare is proposing a rule that would require drug plans to apply ALL discounts received from network pharmacies at the point of sale, so the benefit of the savings can be passed to the beneficiary. This would lead to lower Part D drug costs
Specifically, Medicare is proposing to redefine the negotiated price as the baseline or lowest conceivable payment to the pharmacy starting on January 1, 2023. Senior65.com will update you if these provisions move forward. The new proposal also addresses protection rules, regarding marketing and communications, application evaluation, plan quality ratings, network adequacy criteria, medical loss ratio reporting, and special requirements during disasters or public emergencies. Source