The proposed CMS rule is designed to create a new preferred tier for Part D plans for specialty drugs.
The Centers for Medicare & Medicaid Services (CMS) recently proposed a new payment rule for Medicare Advantage (MA) and Part D plans to spark competition and more rebates for specialty drugs. These rules are significant for patients with chronic illness that require high-cost specialty drugs.
Under the new rules, specialty pharmacy benefit managers–pharmacy benefit managers providing prescription drug management services specifically for those with chronic diseases that require specialty drugs–that offer transparency and launch innovative treatment programs could use their existing tools to negotiate favorable rebates, advocate for patients and reduce costs.
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