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Medicare Beneficiaries to Save Money on Prescription Drugs and More

This month the Centers for Medicare & Medicaid Services (CMS) finalized polices for 2019 to Medicare health and drug plans set to save Medicare beneficiaries money on prescription drugs in addition to offering additional plan choices.

Here’s the highlights of the CMS’ plan to lower the cost of prescription drugs:

  • CMS is going to reduce the maximum amount that low-income beneficiaries pay for certain medicines known as “biosimilars.”
  • Allowing certain low-cost generic drugs be substituted onto plan formularies (drug lists for insurance plans) at any point during the year.
  • Remove the requirement that certain Part D plans have to be very different from each other, making more plan options available, increasing competition among plans.
  • Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.
  • A new rule reduces the amount Medicare will pay for drugs at hospitals that participate in the 340B program, reducing beneficiaries’ coinsurance on Part B drugs at those hospitals. CMS is providing new information to help hospitals implement this change and learn how it works with Medicare Advantage plans.

CMS is also working on redefining the standards for health-related supplemental benefits in the Medicare Advantage program to  cover additional services that increase health and improve quality of life, such as coverage of non-skilled in-home supports and other assistive devices. By expanding the definition of “primarily health related”, CMS will allow supplemental benefits that compensate for any physical impairments, lessen the impact of injuries or health conditions, and/or reduce avoidable ER use.


Lastly CMS is working on final policies for their “Patients Over Paperwork” initiative. This campaign is their attempt to help patients make informed healthcare decisions, remove some of the “Red tape”due to stringent rules and regulations; improve beneficiaries’ customer experience. The final policies will:

  • Authorize CMS to allow plans use of notice of electronic posting (and provision of copies upon request) to meet disclosure requirements for certain documents to Medicare beneficiaries.
  • Provide more transparency regarding Star Ratings which give beneficiaries information about each Medicare Advantage and Part D plan’s quality rating.


Here’s some links to resources with more details on the new CMS rules and plans for 2019:

Fact sheet on the 2019 Rate Announcement and Final Call Letter

Fact sheet on the final rule (CMS-4182-F)

2019 Rate Announcement and Call Letter: select “2019 Announcement.”

Final rule download from Federal Register

As always, be sure to check our blog frequently for any updates on Medicare, Medicaid, Social Security, and Workers’ Compensation. AyudaCon.com is also available for investigation and assistance with your eligibility, application, and/or maintenance of Medicaid and Medicare benefits. Contact us for more information.