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CMS proposes policies to lower the cost of prescription drugs and combat the opioid crisis


Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes a number of changes that, if finalized, will ensure that Part D Medicare enrollees have access to more affordable prescription drugs and more robust prescription drug coverage at the pharmacy they prefer. The rule also gives health plans a new tool to combat the opioid crisis.

The President has been committed to lowering drug prices for seniors and fighting the opioid epidemic. In response, CMS is working to lower drug prices by removing administrative hurdles to offer lower cost options to seniors on Medicare, as well as supporting private sector partners by providing them a much needed tool in the fight to end the opioid epidemic.

CMS is proposing to lower drug costs by providing flexibility for certain mid-year changes to prescription drug formularies when a new generic drug becomes available and is clinically appropriate, while protecting beneficiaries who require the brand name drug. This change will provide flexibility to switch to lower cost prescription drugs and pass those savings on to Medicare beneficiaries.

CMS is also proposing to lower drug costs by treating lower-cost "biosimilar" versions of biologic products like other generic drugs when determining how much certain beneficiaries pay for drugs out of pocket under Medicare Part D. This change will encourage the availability of lower-cost alternatives for Medicare beneficiaries.

The proposed rule also includes a Request for Information on applying discounts drug companies provide to health plans to the price beneficiaries pay at the pharmacy counter. CMS is requesting input on whether this idea would maximize cost-sharing savings for beneficiaries, how they might best be implemented and what the implications would be for various stakeholders and taxpayers.

CMS is also empowering beneficiaries to access their prescription drugs at the pharmacy they prefer. CMS is proposing to revise the pharmacy participation rules in Part D which will promote greater participation of local pharmacies in Part D and preserve beneficiary access to all types of pharmacy delivery services, including mail-order.

To help address the national health crisis created by opioid abuse, CMS is proposing to implement new authority that allows Part D plans to require certain beneficiaries to obtain their prescriptions for opioids from selected prescribers or pharmacies. The proposal would provide an important new tool to combat the growing opioid epidemic that is devastating families and communities across the nation.

For a fact sheet on the proposed rule, please visit:

The proposed rule (CMS-4182-P) can be downloaded from the Federal Register at:


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