Medicare Aims to Lower Drug Costs for Those Enrolled in Part D Plans

What’s going on with Medicare Part D costs?

In early 2022, the Biden administration expressed interest in challenging insurance companies to begin delivering better service to those enrolled in Medicare Part D, the prescription drug coverage portion of one of the nation’s oldest and most popular healthcare policies.


In response, the Centers for Medicare and Medicaid Services (CMS) released a 360-page rule proposal that aims to hold insurance companies accountable for how federal contracts are managed. In addition, the rule would also require insurers to provide proof that they have enough medical professionals available to create new Medicare Advantage Plans, or expand existing ones.


It is CMS’s belief that this new rule will directly address key issues related to the increased role of private insurers in the Medicare marketplace. Currently, much of Medicare is run through public-private partnerships, requiring CMS to keep extensive tabs on healthcare plans that manage federal health benefits for those aged 65 and older.


As a result of this realization, the proposed rule would also have a wide array of benefits for Medicare Part D recipients, potentially lowering out-of-pocket prescription Medication costs significantly for retirees and older individuals with disabilities across the country.


Executive Director of the Program on Medicare Policy at the nonprofit Kaiser Family Foundation, Tricia Neuman, ScD, claimed that the proposed rule (in conjunction with the President’s recent efforts to work with congress to pass the Build Back Better bill) was sufficient evidence to substantiate that the Biden Administration is committed to flexing its authority in an effort to lower prescription drug costs.


“Strengthening protections for seniors in Medicare Advantage plans is particularly important,” due to the large enrollment in these insurer-run programs, Neuman said in a recent email exchange with WebMD.


What’s the impact for Medicare beneficiaries?


For existing or upcoming Medicare Part D beneficiaries, the primary effect of this potential rule change will provide lower out-of-pocket drug costs as well as more transparency with supplemental benefits. If approved, these changes could take effect as early as 2023.


Furthermore, the rule change would place a stronger emphasis on those who are considered to be dually eligible for Medicare and Medicaid, resulting in a “higher standard” of experience for those enrolled in Medicare Advantage and Medicare Part D.


The proposed rule would target dual eligible beneficiaries who are currently enrolled in Dual Eligible Special Needs Plans (D-SNPs), which are often offered by Medicare Advantage organizations.


In a statement related to the rule proposal, CMS administrator Chiquita Brooks-LaSure said the goal for CMS is to, “follow our guiding principles by improving health equity and enhancing access to prescription medications.”


Is this proposed rule change part of a larger Medicare trend in 2022?


This proposed rule change is not the first time that CMS has taken action to potentially improve Medicare prescription medication coverage. Over a year ago, CMS issued a final rule that required Part D plans to begin offering real-time benefit-comparison tools starting in January of 2023.


At the time, CMS claimed the rule was intended to strengthen and modernize the Medicare Advantage and Medicare Part D landscape and allow enrollees more access to information regarding lower-cost alternatives as it pertains to their medication and therapy.


It does in fact appear that CMS, influenced by the Biden Administration’s recent healthcare crackdowns, will continue to take further action to enhance price transparency and fairness to Medicare beneficiaries over the course of 2022 and beyond.


Also, with the agency reporting expectations that the rule changes will save an estimated $75.4 million dollars for the federal government over the next decade, there seems to be no end in sight for these types of advancements.


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