Ritter Insurance Marketing, Craig Ritter

CMS Proposal to Change Medicare Prescription Drug Plan Rules Causes Concerns

Here is the story from Kaiser.  There was a considerable amount of proposed rule making devoted to changes to the Medicare Prescription Drug program (Medicare Part D and Medicare advantage with Prescriptions).  One of the changes involved limiting Plan Sponsor’s ability to offer more than 2 plans.  The proposal would tighten the rules around “meaningful differences” and make it almost impossible to offer 3 different PDP plans.  CMS rules currently allow for 3 plans, although not all companies offer 3.  Also, it tightens rules around Parent companies consolidating plans faster (in cases where a Parent company acquires another company’s PDP business).  It also limits the ability for plans to establish “Preferred Networks”, forcing them to accept any Pharmacy that accepts the terms and conditions of the plan.

The proposed rule would also eliminate immunosuppressive drugs as a protected class of drugs for PDP and MAPD plans.  Here is a link to an article from the American Society of Transplantation on this proposed change.  In addition to immunosuppressives, the proposal would also eliminate antidepressants as a protected class.  Here is a link to that story.  If a drug is in one of the six protected classes, a PDP or MAPD plan must offer all of the drugs available for that category.  If immunosuppressives and antidepressants were removed as protected classes, PDP and MAPD plans would only need to offer 2 drugs for each category.  Currently, PDP and MAPD plans only need to offer 2 drugs for each of the 148 categories of drugs that are not considered “protected” classes.

Critics say that it will eliminate choice and unnecessarily tinker with a successful program.  CMS and advocates say it will simplify choice for Medicare beneficiaries and save the government money.

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