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David White

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule yesterday, November 26, 2018, that includes changes to Medicare Advantage and Part D. Medicare says its proposal will give Part D drug plans more power to negotiate with pharmaceutical companies, but some patient and provider groups say that it will reduce access and shift costs onto beneficiaries.

CMS said in its proposed rule that it would start allowing Part D plans to exclude a drug from the "protected" classes on their formularies if the increase in the drug's price is greater than inflation or if CMS determines that the drug is not a significant innovation over the original product. Current policy requires Medicare Part D plans to cover drugs in the following six categories: