prescription-drug
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CMS Releases Final Part D Rule

May 17, 2019

McDermott+Consulting

On May 16, 2018, the Centers for Medicare and Medicaid Services (CMS) released the final Part D and Medicare Advantage (MA) rule aimed at lowering drug prices.

In the final rule, CMS allows Part D sponsors to use prior authorization (PA) and step therapy (ST) for Part D covered drugs in five the six protected classes (antiretrovirals may not be made subject to PA or ST) while walking back a proposal that would have allowed plans to exclude certain new formulations of protected class Part D drugs and protected class drugs with significant price increases from formulary inclusion. The final rule allows MA Plans and MA Prescription Drug Plans to use utilization management tools, including step therapy as a tool to control drug costs.

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