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Medicare Advantage Prior Authorization and Step Therapy for Part B Drugs

Today, the Centers for Medicare & Medicaid Services (CMS) introduced much-needed competition and negotiation into the market for physician-administered and other Part B medications that will result in better deals and lower drug costs for patients. As part of the agency’s ongoing activities to deliver on President Trump’s promises outlined in his American Patients First Blueprint, CMS will provide Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs in a way that lowers costs and improves the quality of care for Medicare beneficiaries.
Fact sheet

CMS empowers patients with more choices and takes action to lower drug prices

Agency is providing flexibility through private sector tools to negotiate lower prescription drug prices on behalf of beneficiaries.
Press release

Medicare Part D premiums continue to decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline.
Press release

Speech: Medicare Remarks by CMS Administrator Seema Verma at the Commonwealth Club of California

I’d like to talk to you about things on which we all agree, like the future of our healthcare system, and Medicare. And if we have time we can touch quickly on world peace before we all leave.
Press release

CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS commitment to increasing transparency and lowering drug prices.
Press release

CMS proposes Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System changes for 2019 (CMS-1695-P)

On July 25, 2018, CMS proposed changes that would encourage site-neutral payment between sites of services and make healthcare prices more transparent for patients so that they can be more informed about out-of-pocket costs.
Fact sheet

Administrator Verma Statement on FDA’s Biosimilars Action Plan

CMS and FDA are both working to accelerate innovation in the biosimilars market – CMS has taken action to do so by providing biosimilars with separate payment codes and by lowering the amount of cost sharing that low-income beneficiaries pay for biosimilars.
Press release

Administrator Verma Statement on Recent 340B Court Decision

This policy is providing relief every day from the rising costs of drugs, a top priority for President Trump.
Press release

Administrator Verma Statement on the Administration’s Action to Lower Drug Prices

President Trump’s bold leadership to lower drug prices is being heard across the nation. At CMS, we will continue to increase competition, strengthen negotiations, and lower costs for Medicare and Medicaid beneficiaries.
Press release

CMS Approves State Proposal to Advance Specific Medicaid Value-Based Arrangements with Drug Makers

Today, the Centers for Medicare & Medicaid Services (CMS) issued the first-ever approval of a state plan amendment proposal to allow the state of Oklahoma to negotiate supplemental rebate agreements involving value-based purchasing arrangements with drug manufacturers that could produce extra rebates for the state if clinical outcomes are not achieved.
Press release