On Thursday, August 30, the Centers for Medicare & Medicaid Services (CMS) issued two guidance documents to provide clarification to plans participating in the Medicare Part D prescription drug program.

  • Step therapy and Part B drugs: CMS recently announced Part D plans would be permitted to establish “step therapy” programs for Part B drugs starting in 2019. However, CMS’s announcement raised many questions for Part D plans considering participation in this program in 2019. A new Q&A attempts to answer those questions.
  • Indication-based formularies: CMS also released separate guidance that permits Part D plans to develop “indication-based” formularies starting in 2020. Many medications have multiple uses. However, Medicare rules currently require Part D plans to cover a prescription drug without differentiating the conditions for which it is most appropriate. The new rules would change that starting in 2020.

These guidance documents reflect the Trump Administration’s continued interest in reducing prescription drug costs. We expect CMS to announce additional actions in the next several weeks.