News Briefs: CMS Unveils Three Models Aimed at Lowering Drug Costs

CMS on Feb. 14 said the HHS Secretary has chosen three new models for testing by the CMS Innovation Center to help lower prescription drug costs, promote accessibility to life-changing drug therapies, and improve quality of care. The three models address the themes outlined in President Joe Biden’s executive order on lowering drug costs and meet the selection criteria thresholds of affordability, accessibility and feasibility of implementation, according to a Feb. 14 press release. First, the Medicare High-Value Drug List Model will encourage Part D plans to offer a low, fixed copayment across all cost-sharing phases of the Part D benefit for a standardized Medicare list of generic drugs that treat chronic conditions. Patients’ out-of-pocket costs for these generic drugs will be capped at a maximum of $2 per month per drug. Under the second model, the Cell and Gene Therapy Access Model, state Medicaid agencies will assign CMS to coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies. Finally, under the Accelerating Clinical Evidence Model, CMS will develop payment methods for drugs approved under accelerated approval, in consultation with the Food and Drug Administration, to encourage timely confirmatory trial completion and improve access to post-market safety and efficacy data. This would reduce Medicare spending on drugs that have no confirmed clinical benefit, CMS stated.

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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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