Here’s What You May Have Missed in the Biden Admin’s Last Part D Rule
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Dec 12, 2024
Although the provision aimed at broadening coverage of anti-obesity medications garnered the most attention, the Biden administration’s last Medicare Advantage and Part D rule was full of notable proposals for the health insurance industry to unpack. For those in the prescription drug benefits space, there are certain under-the-radar passages that are particularly worth reviewing.
In one of those passages, CMS described several “reports, actions and findings” that indicate Part D plans are excluding generic or biosimilar drugs from their formularies or placing them on higher tiers as pricier branded drugs. In response, the agency said it plans to “include an additional step in the formulary review process to check that Part D sponsors provide broad access to generics, biosimilars, and other lower cost drugs.”
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