United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2019_register executive 2019-05-23 article Part II Rules and Regulations D09002ee1c7d35184 D09002ee1c7d3522c United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency This final rule amends the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to support health and drug plans' negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees. These amendments will improve the regulatory framework to facilitate development of Part C and Part D products that better meet the individual beneficiary's healthcare needs and reduce out-of-pocket spending for enrollees at the pharmacy and other sites of care. 84 FR 23832 https://www.govinfo.gov/app/details/FR-2019-05-23/2019-10521 2019-10521 fr23my19-15 RIN 0938-AT92 4120-01-P CMS-4180-F https://www.govinfo.gov/app/details/FR-2019-05-23/2019-10521 https://www.govinfo.gov/content/pkg/FR-2019-05-23/html/2019-10521.htm https://www.govinfo.gov/content/pkg/FR-2019-05-23/pdf/2019-10521.pdf Administrative Practice and Procedure Health Facilities Health Maintenance Organizations (Hmo) Medicare Penalties Privacy Reporting and Recordkeeping Requirements Emergency Medical Services Health Professionals 53 p. 23832 23884 84 FR 23832 Title 42 Part 422 42 CFR Part 422 Title 42 Part 423 42 CFR Part 423 RIN 0938-AT92 Modernizing Part D and Medicare Advantage To Lower Drug Prices and Reduce Out-of-Pocket Expenses; Federal Register Vol. 84, Issue RULE 2019-10521 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2020-01-01 CMS-4180-F 4120-01-P 2019-10521 Final rule.

This final rule amends the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to support health and drug plans' negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees. These amendments will improve the regulatory framework to facilitate development of Part C and Part D products that better meet the individual beneficiary's healthcare needs and reduce out-of-pocket spending for enrollees at the pharmacy and other sites of care.

These regulations are effective on January 1, 2020, except for the amendments to Sec. Sec. 422.629, 422.631, 422.633, 423.128, and 423.160, which are effective January 1, 2021. Joella Roland, (410) 786-7638 or Christian Bauer, (410) 786-6043, Part D Issues. Administrative Practice and Procedure Health Facilities Health Maintenance Organizations (Hmo) Medicare Penalties Privacy Reporting and Recordkeeping Requirements Emergency Medical Services Health Professionals Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses , http://www.bls.gov/oes/2017/may/oes_nat.htm http://www.bls.gov/oes/current/oes_nat.htm http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Chapter6.pdf http://www.sba.gov/content/small-business-size-standards http://www.who.int/medicines/technical_briefing/tbs/10-PG_Standard-Treatment-Guidelines_final-08.pdf https://dpapportal.lmi.org/DPAPMailbox/Documents/Part%20B%20Step%20Therapy%20Questions%20FAQs_8-29-18.pdf https://obamawhitehouse.archives.gov/omb/circulars_a004_a-4/ https://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf https://www.aad.org/advocacy/state-policy/step-therapy-legislation https://www.actuary.org/content/prescription-drug-spending-us-health-care-system https://www.bls.gov/oes/current/oes_nat.htm https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/index.html https://www.cms.gov/Medicare/Health-Plans/HealthPlansGenInfo/Downloads/MA_Step_Therapy_HPMS_Memo_8_7_2018.pdf https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf https://www.nhqualitycampaign.org/files/Antipsychotic_Medication_Use_Report.pdf https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2018/DCB_h.pdf https://www.pewtrusts.org/en/research-and-analysis/speeches-and-testimony/2019/01/25/pew-comments-on-proposals-to-modernize-medicare-drug-payments https://www.statnews.com/2018/02/05/antipsychotics-nursing-homes-elderly/ https://www.thegazette.com/subject/news/health/iowa-bill-would-allow-exemptions-from-fail-first-insurance-drug-practices-20170318 Vol. 84, no. 100 Office of the Federal Register, National Archives and Records Administration 2019-05-23 continuing daily deposited born digital 293 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2019-05-23 P0b002ee1a12e96d1 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr23my19 https://www.govinfo.gov/app/details/FR-2019-05-23 https://www.govinfo.gov/content/pkg/FR-2019-05-23/pdf/FR-2019-05-23.pdf https://www.govinfo.gov/content/pkg/FR-2019-05-23/xml/FR-2019-05-23.xml fdlp 23703 23989 DGPO 2019-05-23 2024-05-31 FR-2019-05-23 machine generated eng FR FR-2019-05-23 84 100