AHA comments on proposed rule to lower Part D/MA drug prices

AHA today voiced support for a number of proposed changes to the Medicare Advantage and Part D programs aimed at increasing plan negotiating power to lower drug prices, but emphasized “the importance of strong patient protections to ensure continuity of care, the application of medical necessity, an expedited appeals process, and required review and approval of MA step therapy plans by respective Pharmacy and Therapeutic Committees.” The proposed rule would allow Part D plans to exclude certain drugs from their formularies with the objective of negotiating lower drug prices; codify a recent change in policy that allowed MA plans to require beneficiaries to try cost-effective Part B drug therapies before progressing to more expensive options; require Part D plans to implement by 2020 electronic tools to inform prescribers of beneficiary-specific drug coverage and lower-cost therapeutic alternatives available to the enrollee; and require Part D plans to include information about changes in drug prices and lower-cost therapeutic alternatives in their explanation of benefits.