November 17, 2017 / 12:08 AM / a year ago

Trump administration proposes Medicare rules aimed at opioids, drug costs

Nov 16 (Reuters) - The Trump administration on Thursday proposed changes to Medicare drug plans including limits on opioid prescriptions and rules aimed at reducing drug costs for seniors, including requiring health insurers to pass on discounts to consumers.

To help combat overprescription and abuse of addictive painkillers, the U.S. Centers for Medicare and Medicaid Services (CMS) said it was considering allowing drug coverage plans to require certain beneficiaries to obtain prescriptions for opioids only from selected prescribers or pharmacies.

CMS, part of the Department of Health and Human Services, oversees healthcare and drug benefits under the government-paid health plan for older and disabled people, which includes coverage plans managed by private insurers.

The agency said its proposed rule includes a request for information on applying discounts drug companies negotiate with health plans to the price beneficiaries pay at the pharmacy counter. Some drug companies have argued that consumers with high deductibles or other coverage limitations are not getting the benefit of such contracted discounts.

It is also considering a change in treatment of “biosimilar” drugs, which are copies of expensive biotechnology drugs that have lost patent protection. CMS said it may cover lower-cost biosimilars like other generic drugs when determining how much certain beneficiaries pay for drugs out of pocket. The aim is to encourage the availability of lower-cost alternatives for Medicare beneficiaries.

CMS said it is aiming to allow certain midyear changes to prescription drug formularies when a new, lower-cost generic drug becomes available.

The agency also plans to revise pharmacy participation rules to promote greater participation of local pharmacies, while preserving beneficiary access to all types of pharmacy delivery services, including mail-order.

If finalized, the proposed changes would take effect in contract year 2019. (Reporting by Deena Beasley in Los Angeles; Editing by Matthew Lewis)

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