CMS issues final rule on Medicare drug coverage: 5 things to know

CMS released a final rule Jan. 15 that aims to lower cost-sharing for pricey prescription drugs for Medicare Advantage and Part D enrollees.

Five things to know: 

1. The rule requires Medicare Part D prescription drug plans to provide members with a tool that calculates their out-of-pocket drug costs in real-time. Part D plans need to have this tool available to members by Jan. 1, 2023.

2. CMS hopes the rule will help Medicare Advantage and Part D beneficiaries know and compare their out-of-pocket costs for prescription drugs in advance. 

3. Additionally, currently all drugs on a Part D plan's specialty tier, which includes the highest-cost drugs, have the same level of cost-sharing for members. Under the final rule, CMS will allow Part D plans to have a second "preferred" specialty tier that has lower cost-sharing for members. CMS said this change will give Part D plans more negotiating power with drugmakers.

4. CMS will also require Part D plans to disclose pharmacy performance measures to help the agency better understand how the measures are used. CMS will be allowed to report the performance measures publicly. 

5. CMS estimates the changes, most of which are effective for the 2022 plan year, will save the federal government $75.4 million over 10 years. 

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