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Proposed changes are encouraging and have potential to increase transparency, increase shared savings to patients, and reduce burden of high prescription drug prices

April 1, 2022 (ACP) -- The �鶹ֱ��app is pleased by proposed changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs for the calendar year 2023 and hopes they will be adopted.

“Overall, we're encouraged,” said Brian Outland, ACP director of regulatory affairs.

“Particularly, ACP is pleased that the Centers for Medicare & Medicaid Services (CMS) reinstated regulatory protections for physicians and beneficiaries to benefit from improved patient care and outcomes as well as reduce health care costs for out-of-pocket costs for prescription drugs under Part D.”

CMS released the proposed changes in January 2022, and ACP promptly began to analyze them to ensure they meet the needs of patients and physicians. ACP sent a four-page letter to CMS outlining its positions.

According to Outland, the proposed changes to Beneficiary Cost-Sharing Adjustments have the greatest potential to provide transparency, increase shared savings to the patient and reduce the burden that high prescription drug prices put on the health care system.

As CMS noted, “there has been an increased occurrence of Part D plans entering into a type of arrangement with pharmacies that may pay less for dispensed drugs if the pharmacies fail to meet certain criteria set by the plans. Due to the uptick in these arrangements and the process by which the negotiated price is determined, the negotiated price is now frequently higher than the payment pharmacies receive. When the negotiated price increases, so does the cost to the patient.”

CMS proposes changing the system as of Jan. 1, 2023, to “require Part D plans to apply all savings they receive from network pharmacies to the point of sale, so that the patient can also share in the savings.”

ACP does have concerns about proposed changes to Special Needs Plans that serve Medicare-Medicaid dual-eligible patients and beneficiaries with chronic conditions. “While we are supportive of CMS's proposal to include specific questions addressing social drivers of health in the Health Risk Assessments, we expressed concern that permitting a one-question minimum would not reflect the intent of this inclusion,” Outland said. “Additionally, ACP strongly urged CMS to provide adequate protection for the confidentiality of this information. Finally, ACP highlighted that clarification is needed to make certain the questions that would integrate seamlessly with traditional health information and result in successful interoperability.”

According to Outland, the ACP comments dovetail with the College's new letter to a Senate committee warning about rising beneficiary copayments due to the rising cost of prescription drugs. “ACP has been long supportive of reducing prescription drug prices through a cross-industry, patient-centered and multidirectional approach,” he said. “By simultaneously addressing rising beneficiary copayments and many of the issues addressed in this proposed rule, ACP aims to address prescription drug prices in a comprehensive and thoughtful way.”

In the big picture, “the College emphasized in our comments that we welcome the opportunity to work with CMS to better inform the implementation process,” Outland said. “ACP remains committed to achieving health equity, and the Medicare Advantage program is a great pathway to attaining the highest level of health for the individual, despite any factors that affect health outcomes. Members should be encouraged by the positive impact these proposals will have on their practices, their staff and their patients.”

Once CMS has reviewed all of the comments they receive, Outland said, “they will publish a final rule, which we hope will reflect some adjustments based off of our recommendations.”

Back to the April 1, 2022 issue of ACP Advocate