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Medicare Part D Plans May Add ‘Preferred’ Specialty Tiers To Lower Costs

 
• By Cathy Kelly

But cost sharing for non-preferred specialty drugs cannot exceed the current 25%-33% coinsurance currently allowed for the specialty tier, the Centers for Medicare and Medicaid Services says in a proposed rule.

Document with the title Medicare Part D.
Proposal Seeks New Formulary Controls For Specialty Drugs

The Centers for Medicare and Medicaid Services is proposing to allow Medicare Advantage and Medicare Part D plans to add a second, “preferred” specialty drug formulary tier with lower cost sharing beginning in 2021 as a way to “enhance” price negotiations with manufacturers and promote the use of lower-cost biosimilars.

The idea is offered in a

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More from Medicare

If CMS Takes Over 340B, Will Government Allow Rebate Model Changes?

 
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Manufacturers have supported the proposed shift in oversight authority, which could create a more pharma-friendly environment in the drug discount program, but uncertainty remains.

Stand-Alone PDP Market Lives to Fight Another Day, Enrollment Data Shows

 
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No mass exodus was seen from stand-alone prescription drug plans to Medicare Advantage drug plans between 2024 and 2025, according to one actuary.

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The preliminary budget document supports legislation clawing back funds appropriated for the program.

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Wide-ranging executive order to lower drug prices also hints at changes in upcoming guidance on the Medicare price negotiation program but few other potentially impactful near-term actions.

More from Government Payers

If CMS Takes Over 340B, Will Government Allow Rebate Model Changes?

 
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Manufacturers have supported the proposed shift in oversight authority, which could create a more pharma-friendly environment in the drug discount program, but uncertainty remains.

Stand-Alone PDP Market Lives to Fight Another Day, Enrollment Data Shows

 
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No mass exodus was seen from stand-alone prescription drug plans to Medicare Advantage drug plans between 2024 and 2025, according to one actuary.

Companies Advised To Assess Potential Impacts Of Landmark Global Pandemic Treaty

 
• By Neena Brizmohun

Mechanisms in the draft treaty that the more than 190 member states of the World Health Organization have finally agreed to are expected to “materially affect companies,” particularly those that develop, manufacture or distribute pandemic-related health care products.