Medicare Part D Plans Want Preferred Specialty Tier
But Not Limited To Generics And Biosimilars
Payers say Part D plans should have flexibility in determining which drugs to place on a preferred specialty tier, while manufacturers oppose the notion of a second specialty tier altogether.
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But cost sharing for non-preferred specialty drugs cannot exceed the current 25%-33% coinsurance currently allowed for the specialty tier, the Centers for Medicare and Medicaid Services says in a proposed rule.
In the report accompanying FY 2023 HHS appropriations legislation, the House committee also addresses biosimilar uptake in Part D, Medicare dispensing fees for oral COVID-19 drugs and NIH grants for expanded access to investigational ALS drugs.
US legislation attempts to address manufacturer, pharmacy benefit manager impact on patient costs in addition to health plan benefit designs. Critics suggest it’s too easy on manufacturers but that may help its chances with Republicans.