CMS Releases Proposed 2014 Payment Plan for Medicare Part D, Advantage

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For the first time in Medicare Part D's history, CMS would lower beneficiary's deductibles and copays for covered prescription drugs as part of the agency's proposed payment plan for 2014.

Among other features of the proposed rule (pdf) are details regarding the health law's 85 percent medical loss ratio requirement for Medicare Advantage and prescription drug plans. The proposed rule would also forbid plans from raising costs to members more than $30 per member per month, which is even more stringent than the previous cap of $36 per member per month.

Another key element of the rule would be a new requirement on Part D pharmacies to require a beneficiary's consent for each prescription drug delivery unless he or she personally requested the refill. That's a move to help eliminate unwanted shipments to covered Medicare beneficiaries who could be billed for drug shipments they no longer required.

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