CMS Takes Second Shot At Mandating “Trial Size” Prescriptions For Part D; Estimates Savings At $2.5 Billion By 2018
CMS once again has proposed mandating that Medicare Part D prescription drug plan sponsors offer a “trial size” of first-fill prescriptions for medications treating chronic conditions and, in a step further than the previous effort, mandated that the cost-sharing be prorated based on the daily cost of the drug.
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CMS mandates that Part D plans offer prescriptions filled for less than a 30-day period at a daily cost-sharing rate, with a few stated exceptions, but delays implementation until the 2014 plan year.
The Pharmaceutical Research and Manufacturers of America, as well as pharmacy and PBM groups, recommend that CMS test its proposed policy to institute trial-size prescriptions before implementing it on a widespread basis to Medicare Part D.
A Senate hearing examining the prevalence of “doctor shopping” by Medicare Part D enrollees revealed that CMS and the Government Accountability Office disagree on possible tools to address the issue, and perhaps more basically, who is responsible for implementing them.