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CMS Suggests Significant Changes to Medicare Part D and Medicare Advantage Prescription Drug Plans

On January 6, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, “Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs,” (the “Proposed Rule”) with public comments due by March 7, 2014. The Proposed Rule would bring considerable changes to Medicare Part D and Medicare Advantage prescription drug plans. Most significantly, the Proposed Rule would modify the criteria for protected “drug categories or classes of clinical concern,” require preferred pharmacy networks to deliver lower costs to Part D enrollees and the government, and target fraud and abuse by requiring prescribers to enroll in Medicare in order for their prescriptions to be covered under Part D. Read more…


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