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Two-Tier Specialty Drug Policy: Part D Plans Gain Formulary Flexibility But Impact May Be Limited

 
• By Cathy Kelly

Use of preferred and non-preferred specialty formulary tiers will be allowed but preferred tiers are not necessarily limited to generics and biosimilars and coinsurance for non-preferred specialty drugs cannot exceed 33%.

Two Tiers May Sweeten Price Negotiations For Medicare Part D Plans

Medicare Part D plans will have the option of using preferred and non-preferred specialty drug cost sharing tiers in formularies beginning in 2022 in a move the Centers for Medicare and Medicaid Services hopes will promote uptake of less expensive products such as biosimilars.

The dual specialty tier policy is laid out in a final rule establishing contract year 2022 policy and technical...

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