CMS Ensures Greater Transparency Into Prescription Drug Costs

According to a recent press release, the Centers for Medicare & Medicaid Services (CMS) has announced recent improvements to Medicare Advantage and Medicare Part D that ensure greater transparency for the costs of prescription drugs. 

“The improvements we are making to Medicare Advantage and Medicare Part D deliver on the promises in the President’s blueprint to provide more negotiating tools and more transparency for patients,” Health and Human Services (HHS) Secretary Alex Azar said in a statement. “They are significant steps toward a Medicare program, a drug pricing marketplace, and a healthcare system where the patient is at the center and in control.” 

The agency explained that Part D plans will be required to have a negotiating tool that is integrated into clinicians’ electronic prescribing or electric health records systems. “CMS is encouraged that some plans are already offering these tools, but [the new] policy will require all plans to provide clinicians with access to price information for different prescription drugs.”  

In another effort to further promote transparency, the new rule will also require the Explanation of Benefits document include information on drug price increases and lower-cost therapeutic alternatives.  

“As a result of these changes, patients and their clinicians will be able to better understand the cost of prescription drugs and seek out high-value options, helping to increase patient adherence and improving health outcomes.” 

CMS also noted that the new rule will now implement Part D legislation that prohibits “gag clauses.” A gag clause keep pharmacists from telling patients about lower-cost ways to obtain prescription medications.  

“These efforts to promote transparency on the price of prescription drugs complement a series of other changes towards this important goal,” the agency said, “including a final rule issued by CMS last week to require pharmaceutical companies to disclose the list price of prescription drugs in direct-to-consumer television advertisements.”

“Under President Trump’s leadership, CMS is delivering on price transparency, because patients have a right to know the cost of their healthcare services before they receive them,” CMS Administrator Seema Verma, MPH, said in a statement.  

“Today’s rule requires Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket costs for prescription drugs at the time a prescription is written. By empowering patients with information on the cost of their prescription drugs, today’s rule will ensure that pharmaceutical companies have to compete on the basis of price. This effort builds on new requirements for hospitals to disclose chargemaster prices and other agency initiatives to promote price transparency.” 

A fact sheet is available about the final rule. Click here to access the fact sheet. 

—Julie Gould 

Reference:

The Centers for Medicare & Medicaid Services. CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency [press release]. https://www.cms.gov/newsroom/press-releases/cms-takes-action-lower-prescription-drug-prices-and-increase-transparency. Published May 16, 2019. Accessed May 17, 2019.