CMS may force Part D plans to offer real-time pricing data to members
The CMS issued the second part of its annual Advance Notice governing Medicare Advantage and Part D plans today. In it, the agency proposes a requirement for plans to offer real-time pricing comparisons to members. If the new proposal is put in place, Part D plans would have to offer real-time drug pricing data to members in 2022. Plans would be required to offer direct price comparisons between formulary options and provide data on cost sharing. In addition, CMS proposes allowing Part D plans to offer a second specialty drug tier on their formulary for “preferred” specialty medications, allowing for more options with lower cost sharing. Other proposals in the rule include:
An average M/A rate increase of 0.93% for the 2021 plan year. CMS estimates risk scores could go up by 3.6% on average when accounting for underlying coding trends. CMS finalized a 2.53% rate increase for the 2020 plan year.
Star ratings adjustments that consider a Part D plan’s use of generics and M/A star ratings to reflect beneficiary feedback.