BioCentury
ARTICLE | Politics & Policy

CMS opens private-sector negotiation to Medicare Part B

August 8, 2018 3:14 AM UTC

CMS unveiled details of a policy under the Trump administration's drug pricing blueprint that will apply private-sector negotiation tools into some Medicare Part B plans and create competition between Part B and D drugs. Plans that adopt the changes will be required to return 50% of the savings generated through its use to patients.

Beginning on Jan. 1, 2019, Medicare Advantage plans -- which cover 20 million Americans, or 33% of Medicare enrollees -- have the option to adopt a step therapy approach to Part B drugs. CMS highlighted the use of this new change to get patients on to biosimilars. Plans that opt in can require beneficiaries with a newly diagnosed condition to begin treatment with the plan's preferred drug therapy -- such as a more cost-effective biosimilar -- before progressing to a most costly drug therapy if the initial treatment is ineffective...