CMS Trims Rule on Part D, Medicare Advantage in Final Version


The Centers for Medicare & Medicaid Services May 19 released a watered-down final rule governing Medicare’s managed care and prescription drug programs that eschewed numerous controversial provisions from the proposed rule and instead focused on curbing fraud and abuse and increasing transparency.

The final rule, expected to be published in the May 23 Federal Register, expands rewards and incentive programs focusing on encouraging participation in activities that promote improved health, efficient use of health-care resources and preventing injuries and illness and also broadens the release of privacy-protected data, the CMS said.

The proposed rule issued in January contained a variety of controversial changes to the Medicare Advantage and Part D programs, including changes to criteria for protected drug classes, preferred pharmacies and the medication therapy management programs.  After an uproar from Congress and the public, CMS Administrator Marilyn Tavenner said in March the agency wouldn't make final the proposals relating to the protected classes definition on three drug classes, standards for preferred pharmacy networks, the number of Part D plans sponsors may offer and clarifications to the noninterference provision.