CMS Backs Down on Medicare Advantage Drug Overhaul

Responding to a storm of complaints from patient groups and a letter from 30 bipartisan Congressional representatives, the Centers for Medicare and Medicaid Services (CMS) backed down on a plan to overhaul drug coverage under the Medicare Advantage (Part C) and Part D prescription drug program.  The CMS’ proposed rule would have ended the protected status of antidepressants and immunosuppressant drugs (transplant drugs) starting in 2015 and anti-psychotic drugs potentially in 2016.

In a letter to Congress, CMS Administrator Marilyn Tavenner says that CMS now plans to only finalize proposals related to consumer protections (ensuring access to care during natural disasters), anti-fraud provisions that have bipartisan support (strengthening standards for prescribers of prescription drugs), and transparency (broadening the release of privacy-protected Part D data) after taking into consideration the comments received during the public comment period. Pharmaceutical Care Management Association (PCMA) president and CEO Mark Merritt said, “CMS was wise to reconsider its proposed Part D rule that would have destabilized the program, increased costs, and disrupted coverage for millions of seniors.”

Last Updated 08/10/2022

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