January 23, 2020 — The Centers for Medicare & Medicaid Services (CMS) issued a final rule that will allow enrollees to know in advance and compare their out-of-pocket payments for different prescription drugs. The changes are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs.
The final rule will require Part D plans to offer a real-time benefit comparison tool starting January 1, 2023, so enrollees can obtain information about lower-cost alternative therapies under their prescription drug benefit plan. Enrollees would be able to compare cost sharing to find the most cost-effective prescription drugs for their health needs. For example, if a doctor recommends a specific cholesterol-lowering drug, the enrollee could look up what the co-pay would be and see if a different, similarly effective option might save the enrollee money. With this tool, enrollees will be better able to know what they will need to pay before they are standing at the pharmacy counter.
Thanks to Tom Cretella for letting us know about this new development.
For further reading:
Medicare Fact Sheet