(Reuters) – The Trump administration on Thursday proposed adjustments to Medicare drug plans together with limits on opioid prescriptions and guidelines geared toward decreasing drug prices for seniors, together with requiring well being insurers to move on reductions to shoppers.
To assist fight overprescription and abuse of addictive painkillers, the U.S. Facilities for Medicare and Medicaid Providers (CMS) mentioned it was contemplating permitting drug protection plans to require sure beneficiaries to acquire prescriptions for opioids solely from chosen prescribers or pharmacies.
CMS, a part of the Division of Well being and Human Providers, oversees healthcare and drug advantages below the government-paid well being plan for older and disabled individuals, which incorporates protection plans managed by non-public insurers.
The company mentioned its proposed rule features a request for info on making use of reductions drug firms negotiate with well being plans to the value beneficiaries pay on the pharmacy counter. Some drug firms have argued that buyers with excessive deductibles or different protection limitations should not getting the advantage of such contracted reductions.
It is usually contemplating a change in remedy of “biosimilar” medicine, that are copies of pricey biotechnology medicine which have misplaced patent safety. CMS mentioned it could cowl lower-cost biosimilars like different generic medicine when figuring out how a lot sure beneficiaries pay for medicine out of pocket. The purpose is to encourage the supply of lower-cost options for Medicare beneficiaries.
CMS mentioned it’s aiming to permit sure midyear adjustments to prescription drug formularies when a brand new, lower-cost generic drug turns into obtainable.
The company additionally plans to revise pharmacy participation guidelines to advertise better participation of native pharmacies, whereas preserving beneficiary entry to all varieties of pharmacy supply providers, together with mail-order.
If finalized, the proposed adjustments would take impact in contract 12 months 2019.
Reporting by Deena Beasley in Los Angeles; Modifying by Matthew Lewis
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