Out-of-pocket prescription drug costs for beneficiaries with Medicare Part D could start to lower with improved price transparency and market competition thanks to a January 2022 proposed rule from the Centers for Medicare and Medicaid Services (CMS). The rule, which would take effect on January 1, 2023, would improve beneficiaries’ experiences with Medicare Advantage and Medicare Part D and work to improve health equity in the programs, according to CMS.
Pharmacy price concessions—arrangements between Medicare Part D plans and pharmacies where plans pay less money to pharmacies for dispensed drugs if the pharmacy does not meet certain metrics—are not currently available publicly, and the lower prices are not passed along to the beneficiary at the point of sale. CMS’s proposed policy would reduce beneficiaries’ Medicare Part D out-of-pocket costs and improve price transparency and market competition.
In addition, the proposed rule would authorize the agency to:
- Take steps to improve experiences for dually eligible beneficiaries who are enrolled in Dual Eligible Special Needs Plans offered by Medicare Advantage organizations.
- Propose actions that reduce health disparities by ensuring all Medicare Advantage special needs plans solicit information about an individual’s barriers to accessing care.
- Protect beneficiaries by holding plans to a higher standard when reviewing applications for new or expanded plans.
“We are dedicated to ensuring older Americans and those with disabilities who are served by the Medicare program have access to quality, affordable health care, including prescription drugs and therapies,” CMS Administrator Chiquita Brooks-LaSure said.