1. Pink Sheet
  2. >>Market Access

Part D Copay Smoothing: Manufacturers Excluded From Financial Reconciliation Process

 
• By Cathy Kelly

Aiming for a threshold that ‘strikes the best balance,’ the final guidance from Medicare requires that plan sponsors and pharmacies use $600, single-prescription cost sharing at the point of sale to identify enrollees likely to benefit from the smoothing program and inform them about the option.

Part D Cost Sharing Can Be Spread Out Over The Year Beginning In 2025 • Source: Shutterstock (Shutterstock)

Manufacturers may not engage in the financial reconciliation process between Medicare Part D plans and beneficiaries as part of the cost sharing “smoothing” program established by the Inflation Reduction Act, according to final guidance by the Centers for Medicare and Medicaid Services.

Key Takeaways

  • Manufacturers can’t insert themselves in the reconciliation process between plans and beneficiaries, final guidance says.

  • Beneficiaries with $600 single script cost sharing bill will...

The smoothing program is intended to make it easier for beneficiaries with very high-cost prescriptions to afford their co-pays by permitting monthly installments rather than demanding collection of the whole...

Read the full article – start your free trial today!

Join thousands of industry professionals who rely on Pink Sheet for daily insights

  • Start your 7-day free trial
  • Explore trusted news, analysis, and insights
  • Access comprehensive global coverage
  • Enjoy instant access – no credit card required
Start Free Trial

Already a subscriber?

More from Market Access

US FDA’s Familiar Drug Pricing To-Do List

 
• By Michael McCaughan

President Trump’s new Executive Order on drug pricing reprises several policy themes from his first administration, including giving the FDA many tasks intended to increase competition in the marketplace.

Why Hympavzi Secured English Funding For Hemophilia B But Not Hemophilia A

 
• By Neena Brizmohun

Pfizer told the Pink Sheet it would work with the health technology assessment institute, NICE, with the hope of making Hympavzi available to patients with hemophilia A via the National Health Service.

US Most Favored Nations Policy: Higher Drug Spending In Germany Is ‘Difficult To Imagine’

 
• By Francesca Bruce

Germany’s federal health care decision-making body, the G-BA, tells the Pink Sheet that German drug prices are fair and speculation of price rises in the market due to the US MFN policy is fear mongering.

Japan Reimburses 11 New Drugs But Slashes Price Of Others By Up To 20%

 
• By Lisa Takagi

Japan's NHI program continues to give and take as 11 new drugs are granted reimbursement, while the prices of others - including three ophthalmic therapies - are cut by up to 20% under a Market Expansion Repricing scheme.

More from Pink Sheet

EU To Track Decentralized Clinical Trials In CTIS To Support Innovation

 
• By Vibha Sharma

Monitoring the use of decentralized elements in clinical trials is a priority for the European medicines regulatory network.

Why Hympavzi Secured English Funding For Hemophilia B But Not Hemophilia A

 
• By Neena Brizmohun

Pfizer told the Pink Sheet it would work with the health technology assessment institute, NICE, with the hope of making Hympavzi available to patients with hemophilia A via the National Health Service.

Europe’s UPC Issues Landmark Ruling On Second Medical Use Claims

 
• By Neena Brizmohun

The verdict by the Unified Patent Court in the dispute between Sanofi/Regeneron Pharmaceuticals and Amgen explains what companies should look out for when deciding whether infringement has taken place when it comes to second medical use patents.