CMS finalizes rule that forces Part D plans to launch price comparison tool for members

The Trump administration has finalized a rule that would force Medicare Part D plans to launch a real-time price comparison tool for members.

The rule takes effect Jan. 1, 2023, Centers for Medicare & Medicaid Services (CMS) officials said. The goal, according to the agency, is for plans to offer a tool that customers can use to find alternative, lower-cost therapies that may be available to them.

Customers should be armed with data that make clear what they'll have to pay before they get to the pharmacy counter, CMS officials said.

“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” said CMS Administrator Seema Verma in a statement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”

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CMS earlier finalized regulations that force Part D plans to make the real-time benefits data available to providers beginning this year.

The final rule also codifies a proposal to allow Part D plans to create a second "preferred" tier for specialty drugs, which CMS says should allow insurers to negotiate better prices with drug manufacturers in exchange for placement on that formulary tier.

Drugs included on the preferred tier would have lower cost-sharing than those on the traditional specialty tier, CMS said.

In addition, CMS will now require Part D plans to disclose pharmacy performance measures to the agency, which CMS will use to track how such measures are applied. CMS said that pharmacies have expressed concern that the measures are hard to obtain or are unfair.

"CMS will also be able to report pharmacy performance measures publicly to increase transparency on the process and to inform the industry in its new efforts to develop a standard set of pharmacy performance measures," the agency said in a release.