CMS Unveils New Part D Model to Lower OOP Insulin Costs

Under the backdrop of a public health emergency and the White House pressuring Congress to pass drug pricing legislation, CMS on March 11 unveiled a new Innovation Center model that it expects will lower out-of-pocket (OOP) insulin costs by roughly 65% for enrollees of participating Part D plans. Nevertheless, health policy experts say the model is rather limited and likely won’t drive a fundamental shift in Part D drug pricing.

Under the five-year Part D Senior Savings Model, CMS will test a change to the Manufacturer Coverage Gap Discount Program by waiving current rules for supplemental benefits used to reduce cost sharing in the coverage gap and enabling Part D sponsors to offer enhanced alternative plan benefit packages (PBPs) that feature “standard, predictable” copayments through all phases of the Part D benefit up to catastrophic coverage. Participation from manufacturers and plans is voluntary. Innovation Center head Amy Bassano, during a March 12 webinar, said CMS recognizes that plans and other stakeholders are busy addressing the coronavirus outbreak (see story, above), but the agency is hoping for “robust participation and interest…given how critical it is to ensure that our seniors have access to insulin.”

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Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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