CMS Proposes Rule to Codify Medicare Drug Price Negotiation Program
CMS has issued a proposed rule to codify the Medicare Drug Price Negotiation Program and establish new policies for both the Negotiation Program and the Medicare Prescription Drug Benefit Program as required by the Inflation Reduction Act of 2022. The rule also proposes modifications to the fixed combination drug policy. The Negotiation Program allows Medicare to negotiate prices for certain high-cost drugs, which could affect formulary dynamics and pricing strategies for Medicare Advantage plans that include prescription drug coverage. The proposed rule sets the framework for how negotiated prices will be implemented and administered.
While this rule directly affects Medicare Part D plans, dual-eligible beneficiaries enrolled in Medicaid managed care plans may see pharmacy benefit coordination changes, and negotiated drug prices could create pressure for similar Medicaid supplemental rebate strategies.
Pharmacy · Managed Care
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