CMS Finalizes 2019 Drug Payment Changes, Opioid Policies for Part D

The Centers for Medicare and Medicaid Services (CMS) on Monday issued a final Medicare Part D rule to expand access to more affordable drugs, and also outlined new opioid limits, reports Politico Pro . The drug cost revisions should lower cost-sharing for some beneficiaries and may provide some savings for taxpayers, but they will not directly affect the prices drug companies charge. The final rule for the 2019 Medicare prescription drug program mandates plans must lower maximum co-payments for biosimilar drugs for people who receive low-income subsidies. CMS says this change should save beneficiaries $10 million in 2019, without changing what plans pay for the biosimilars. The rule also allows Part D plans to immediately substitute newly released generics for brand-name drugs at the same or lower cost-sharing if they come on the market during the plan year. However, CMS will not require insurance plans to share a portion of the rebates they negotiate with drug companies directly with beneficiaries buying the drug, and beneficiaries will be permitted to receive drugs at whichever pharmacy they prefer. Furthermore, the rule implements provisions in the Comprehensive Addiction and Recovery Act of 2016 allowing Part D plans to deploy drug management programs that can limit at-risk beneficiaries' access to frequently abused drugs, including opioids and benzodiazepines. Plans can require that at-risk beneficiaries receive the drugs from only one selected provider or pharmacist. People with cancer, in hospice, those receiving end-of-life or palliative care, and those at risk for prescription drug abuse who are in drug management programs will get exemptions. In addition, health plans must limit initial opioid prescriptions for acute pain to a maximum seven-day supply.