TL/DR –
The article discusses the pending changes to Part D in the United States, along with the potential risks to beneficiaries due to plan sponsors’ altered incentives based on the IRA. In anticipation of the year 2025, which is when these alterations will speed up, the Centers for Medicare & Medicaid Services (CMS) can take steps to preserve beneficiary access and increase transparency. CMS has already instructed Prescription Drug Plan (PDP) sponsors not to place negotiable drugs on non-preferred formulary tiers without clinical justification.
Implementing Part D Changes Ahead of 2025
Anticipating the acceleration of Part D redesign changes by 2025, CMS could preserve beneficiary access and increase transparency as part of the IRA implementation. CMS has already cautioned PDP sponsors against placing negotiated drugs on non-preferred formulary tiers without clinical justification, but it can further utilize its current legal authority.
This article elaborates on the forthcoming changes to Part D, risks for beneficiaries due to changing incentives from IRA plan sponsors, initial beneficiary protection measures by CMS, and potential steps CMS could take to ensure timely access to therapy for beneficiaries.
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This article serves as a general guide and specialist advice should be sought for specific circumstances. More information can be found here.
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