Medicare Advantage and Part D Rule: A win for patients, but out-of-pocket costs must be capped


The following is an excerpt from an op-ed by National Health Council Chief Executive Officer Marc Boutin, published on July 25, 2019 in The Hill. Read the full article here.

Taking steps to control costs while ensuring high-quality care, empowering patients with information, and improving transparency across our health care system are critical. That is why after months of advocating for patient protections and transparent pricing, the National Health Council (NHC) was pleased the Centers for Medicare and Medicaid Services (CMS) finalized its Medicare Advantage and Part D Prescription Drug Price Rule, which maintained proposed transparency provisions that the NHC supported, while removing or mitigating harmful proposed provisions.

We fully support efforts to increase price and cost-sharing transparency, and for the implementation of robust mechanisms to ensure any price concessions extended to Part D Plans are passed on to patients. However, there is also a need for an out-of-pocket cost cap – something Congress is currently debating.

Originally, we had significant concerns with the administration’s proposal to give Medicare plans more flexibility to impose new barriers, keeping patients from receiving needed medicines in a timely fashion. For example, changes to the Medicare Part D six protected classes would have allowed plans to stop covering some medicines for conditions such as cancer, mental health illnesses, and HIV/AIDS. We are pleased that CMS rolled back these changes. We thank the administration for listening to the concerns of beneficiaries and for not restricting access to needed medications.

Read the full article here.