Pharmacy Benefits and PBM Contracting
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CMS Releases Part Two of Guidance for the Inflation Reduction Act’s Medicare Prescription Payment Plan
February 27, 2024 | Blog | By Tara E. Dwyer, Lauren Moldawer, Madison Castle
On February 15, 2024, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Prescription Payment Plan Draft Part Two Guidance (Part Two Guidance) as part of the Inflation Reduction Act’s (IRA) efforts to tackle high prescription drug costs. The Medicare Prescription Payment Part Plan (the Program), which was previously referred to as the “OOP Smoothing Program”, was established as part of the IRA and requires Part D plans (PDPs) to offer their members an option to pay for out-of-pocket (OOP) prescription drug costs in monthly capped payments, as opposed to all at once, at a pharmacy. Meaning, for members who opt-in to the Program, they will pay $0 at the pharmacy and the PDP must pay the pharmacy the full cost-sharing amount of the drug and then bill the member the amount of the cost-sharing over the remainder of the calendar year.
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Mintz IRA Update — Removal of AMP-Cap on Medicaid Rebates Causes Insulin Price Decrease
February 21, 2024 | Blog | By Bridgette Keller, Madison Castle, Abdie Santiago
Mintz IRA Update — Inaugural Edition
September 20, 2023 | Blog | By Theresa Carnegie, Tara E. Dwyer, Mitchell Clough, Xavier Hardy, Stephnie John, Bridgette Keller, Lauren Moldawer, Pat Ouellette, Hassan Shaikh
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