Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule updating Medicare Advantage and the Part D prescription drug program for contract year 2019. Among the proposed changes, CMS would codify the current Quality Star Rating System for Medicare Advantage and Part D plans, eliminate the “meaningfully different” standard that Medicare Advantage organizations must meet if they offer multiple plans in the same county and change the open enrollment period to Jan. 1 through March 31.
CMS also solicits comments on how Part D plan sponsors — through their pharmacy benefit managers — negotiate drug price concessions from drug manufacturers, network pharmacies and other entities. Specifically, CMS is interested in learning if Part D plans and their pharmacy benefit managers are lowering premiums and cost-sharing for beneficiaries because of the savings generated from price concessions.
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