CMS Takes on Drug Costs, Opioid Epidemic with New Policies

The Centers for Medicare & Medicaid Services (CMS) recently proposed a rule that aims to ensure Medicare beneficiaries have access to a wider variety of more affordable drugs, while also combatting the opioid epidemic, according to a press release.

The Trump administration has previously advocated for lowering drug prices; however, it has yet to approve legislation that addresses the issue.

In line with the goals of the Trump administration, CMS plans to eliminate hurdles that stand in the way of lower cost options for Medicare beneficiaries. The agency also plans to support private sector partners by providing a novel tool to help fight the opioid epidemic, according to the release.

Under the policy, the CMS will provide increased flexibility for changes to prescription drug formularies when generic drugs are launched. The changes will encourage generic adoption when clinically appropriate, but protect access to the branded drugs for beneficiaries who require the therapy, according to the release.

The CMS said this change will promote flexibility to switch to lower cost therapies and pass potential savings to beneficiaries, according to the release.

Another part of the plan to lower drug costs is the implementation of a rule that treats biosimilars similarly to generic drugs in terms of out-of-pocket costs. This change aims to further access to low-cost, effective alternatives for beneficiaries.

Additionally, the proposed rule includes a Request for Information for manufacturer discounts and the price paid at the pharmacy. The CMS is asking for comments on whether this plan would increase cost savings for patients, how the changes may best be implemented, and how this would affect stakeholders and taxpayers, according to the release.

The rule would give beneficiaries the ability to fill prescriptions at a wider range of pharmacies. The revision to the pharmacy participation rules aim to promote local pharmacy participation in Part D, while allowing patients to access various pharmacy delivery services.

Lastly, the CMS is proposing that Part D require beneficiaries to receive their opioid prescriptions from certain prescribers and pharmacies to help fight the opioid epidemic. This proposal may prevent prescribing practices that have caused an uptick in opioid dependence.