Trump’s Last-Minute Medicare Part D Rule Could Stand

On Jan. 19, the last full day of the Trump administration, CMS finalized a grab-bag rule that includes several drug pricing components. Experts tell AIS Health that the rule could tie the Biden administration to aspects of the Trump administration’s drug pricing agenda.

One requires Medicare Part D plans to offer a consumer-facing real-time benefit tool (RTBT) that grants enrollees instant formulary and benefit information, including an accurate estimate of their point-of-sale cost sharing. Another allows Part D plan sponsors to implement a second formulary tier for specialty drugs with a lower cost-sharing amount than their existing specialty tier beginning Jan. 1, 2022. The regulation also requires plans to report their internal, qualitative pharmacy evaluation data to CMS. Other notable elements of the rule include new requirements to address opioid overprescribing and misuse.

© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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