CMS Final Cost Rule

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The Centers for Medicare and Medicaid (CMS) has issued a final rule on drug price transparency.  It requires all Medicare Advantage and Part D plans to offer a drug price transparency tool that can be integrated into physician Electronic Health Records (EHRs). This rule will come into effect after a time period that allows EHR developers and healthcare providers to obtain the technology.

“For those who are Medicare-eligible  with drug coverage through a stand-alone Part D drug plan or a Medicare Advantage Prescription Drug plan, the rule requires these plans to include price transparency and low-cost drug alternative lists in their monthly explanation of benefits (EOB) letters to beneficiaries that they already receive…

“Today’s rule requires Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket costs for prescription drugs at the time a prescription is written,” CMS Director, Seema Verma, said. “By empowering patients with information on the cost of their prescription drugs, today’s rule will ensure that pharmaceutical companies have to compete on the basis of price. This effort builds on new requirements for hospitals to disclose chargemaster prices and other agency initiatives to promote price transparency.”

There is also a mandate included in the provisions to empower clinicians by letting them negotiate prices for physician-administered medications, thereby lowering the cost to patients. Most of these medications are biologics, which CMS acknowledged are exceptionally expensive.

As more biosimilars come to market for these drugs, physicians must be empowered to negotiate lower-cost options on behalf of their patients, CMS suggested.

“Additionally, the final rule outlaws pharmacy “gag clauses,” which are payer-imposed rules that prohibit pharmacists from informing patients about lower-cost medication options.

Reference: Sara Heath, “PatientEngagementHIT”



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