Changes to MA and Part D will provide better coverage, more access and improved transparency for Medicare beneficiaries

CMS issued a final rule designed to reduce cost sharing for enrollees in Medicare Advantage and Part D prescription drug programs. The changes will result in an estimated $75.4 million in savings to the federal government over the course of a decade. The final rule will require Part D plans to implement a real-time benefit comparison tool starting January 1, 2023, so enrollees can obtain information about lower-cost alternative therapies under their prescription drug benefit plan. Enrollees would have a better idea of what they will need to pay before they arrive at the pharmacy counter. A similar CMS requirement for Medicare Part D plans that took effect on January 1, 2021, allows users to access a real-time drug benefit tool. Enrollees choose the prescription drug plan that is suitable for their needs. Under the final rule, CMS is allowing Part D plans to have a second, “preferred” specialty tier with a lower cost sharing level than their other specialty tier. This change gives Part D plans more tools to negotiate better deals with manufacturers on the highest-cost drugs and lower out-of-pocket costs for enrollees in exchange for placing these products on the “preferred” specialty tier.