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Changes Halted on Medicare Prescription Drug Program

After receiving bipartisan opposition and heavy concern from patient groups and insurers, the Centers for Medicare and Medicaid Services (“CMS”) has declared that it will not be moving forward with draft regulations released in January which proposed several changes to the Medicare Part D program.

The proposed regulations included a proposal to set a higher standard for the Part D requirements that plans pay for “all or substantially all” drug offerings in six protected drug categories. Also included in the proposal was a controversial requirement that each sponsor offer no more than two Part D plans in the same service area, as well as a provision that would set standards for plans’ preferred provider networks, including requiring that those networks include any pharmacy that agrees to accept the terms. Independent, community pharmacies were upset by the choice to abandon the “any willing pharmacy” provision, as the larger retailers and mail-order services currently enjoy about 70% of the Part D Plan market. The larger response, however, was relief.

During the comment period, which ended March 7, the Healthcare Leadership Council initiated a letter to CMS that was signed by 371 patient advocacy groups, drug manufacturers, health plans and provider organizations urging CMS to abandon the proposed changes.

This article is intended as a summary of federal or state law and does not constitute legal advice.

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