As the election season heats up, drug prices are coming under even more scrutiny and causing a ripple effect on Medicare Part D.

In late July 2020, President Trump signed an executive order that would revive a proposed rule (which had been withdrawn in 2019) to eliminate the rebates that pharmacy benefit managers (PBMs) on Part D plans receive from manufacturers. The order specifically refers to rebates “that drug manufacturers provide to health plan sponsors, pharmacies, or PBMs in operating the Medicare Part D program.” (At the same time, President Trump issued three other executive orders aimed at controlling drug prices).

In the executive order targeting rebates, President Trump wrote that, “rebates are the functional equivalent of kickbacks, and erode the savings that could otherwise go to the Medicare patients taking those drugs.”

For now, the impact of the order is unclear. But because the order calls on the Secretary of Health and Human Services to take action on the proposed rule after confirming that such a rule would not increase federal spending, Medicare premiums, and out-of-pocket costs for patients, the proposed rule may not actually be finalized, according to the National Law Review.

Preferred Specialty Tier, Drug Price Comparison Tools Coming To Part D

We recently updated our Medicare Part D and Medicare/Medicaid Formulary modules to include the executive order as well as more concrete changes coming to Medicare Part D. This includes the addition of a second, “preferred” specialty formulary tier starting in January 2021, which allows Part D plans to put more pressure on manufacturers to lower prices in exchange for preferred placement. CMS will also require Part D plans to provide drug price comparison tools for beneficiaries starting in 2022.

Medicare Part D Training For Pharmaceutical Sales Reps

Because more changes to Part D are inevitable, especially in today’s political environment, we’ll make sure your team has the latest information they need to stay informed. 

Whether you need a custom learning program on Medicare or an off-the-shelf resource on Part D, our learning strategists are here to help. Contact us at (800) 328-2615 or at solutions@cmrinstitute.org to find out more about how we can help your account managers and sales reps improve their industry knowledge and performance.

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