The CMS Changes Coming To Medicare Part D Market

By Margaux Hall and Stephanie Webster (May 17, 2022, 4:37 PM EDT) -- On April 29, the Centers for Medicare & Medicaid Services issued a final rule revising the way Medicare determines the negotiated price — i.e., the price upon which beneficiary cost sharing is based at the pharmacy counter — under Medicare Part D.[1]

The 2022 final rule revises the definition of "negotiated price" to mean the lowest possible reimbursement a network pharmacy will receive in total for a covered Part D drug.[2] The final rule adopts this new definition of negotiated price across Part D, including the Medicare Coverage Gap Discount Program.

The final rule could likely have several effects on the Medicare...

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