CMS Targets Protected Classes in Expanded Part D Demo

As one of its last actions under the Trump administration, CMS said it would give plan sponsors participating in its Medicare Part D Payment Modernization model more flexibility to slim down their formularies, even for protected classes of drugs. The changes to the model — which were included in the demo’s 2022 request for applications issued Jan. 19 — will also eliminate downside financial risk for plan sponsors, although that risk would return in 2023.

It’s unclear what effect these changes would have, since there’s currently been very low uptake of this voluntary model from the CMS Center for Medicare & Medicaid Innovation, with only two plans participating nationwide.

© 2022 MMIT
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