publication date: Nov. 30, 2018

Cancer groups: CMS proposal to lower drug prices would limit access for patients in “protected classes”

By Matthew Bin Han Ong

The Centers for Medicare and Medicaid Services has proposed a drug-pricing plan that administration officials say would offer lower cost options to seniors and provide support for the private sector to lower the cost of prescription drugs.

The Nov. 26 proposed rule was designed to meet the goals President Donald Trump set out in his Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs document, published in May. The proposed rule is open for public comment through Jan. 25, 2019.

The proposed changes include:

Providing Part D plans with “greater flexibility” to negotiate discounts for drugs in protected therapeutic classes, so that beneficiaries who need these drugs will see lower costs.

Requiring Part D plans to increase transparency and provide enrollees and their doctors with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written;

Codifying a policy similar to the one implemented for 2019 to allow “step therapy” in Medicare Advantage for Part B drugs, encouraging access to high-value products including biosimilars; and

Implementing a statutory requirement, recently signed by Trump, that prohibits pharmacy gag clauses—which originally prevented pharmacists from informing patients of cheaper alternatives—in Part D.

The protected classes in Part D include drugs in six categories: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. The antineoplastics category includes many oral chemotherapy drugs.

“Typical private market discounts for these drugs are in the 20 to 30 percent range, but the average discount across all protected classes in Part D is just 6 percent,” HHS Secretary Alex Azar and CMS Administrator Seema … Continue reading Cancer groups: CMS proposal to lower drug prices would limit access for patients in “protected classes”

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