CMS’ Finalized Rules Will Lower Drug Costs & Increase Consumer Protections

drug costs - wood scales with stack of pills

In late April, the Centers for Medicare and Medicaid Services (CMS) issued finalized rules to both strengthen consumer protections in Medicare Advantage and Part D drug plans, and reduce out-of-pocket drug costs for beneficiaries.

As summarized in CMS’ recent fact sheet, this final rule revises the MA and Part D regulations related to marketing and communications; the criteria used to review applications for new or expanded MA and Part D plans, including compliance with MA provider network adequacy requirements; quality ratings for MA and Part D plans; medical loss ratio reporting; special requirements during disasters or public emergencies; how MA organizations calculate attainment of the maximum out-of-pocket (MOOP) limit for Parts A and B services; and the use of pharmacy price concessions to reduce beneficiary drug costs for prescription drugs under Part D. This final rule also revises regulations for D-SNPs, and in some cases, other special needs plans, related to enrollee advisory committees, health risk assessments, and ways to improve integration of Medicare and Medicaid. Many finalized policies are based on lessons learned from the Medicare-Medicaid Financial Alignment Initiative.

For details on these revisions and improvements, see the fact sheet, CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F).

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.