AMA Supports Biden's Medicare Proposal, Prescription Drug Policies

The American Medical Association (AMA) recently strongly supported the Biden Administration's proposal for Medicare Advantage (MA) and prescription drug benefit policies in an official letter.

In the proposed rule, CMS revised the regulations governing maximum out-of-pocket (MOOP) limits for MA plans to require that costs accrued under the plan benefit packages count towards the MOOP limit.  

The current policy proposal would not raise Medicaid cost-sharing payments for dually eligible patients to the total Medicare rates. Still, it would improve equity under the MOOP limit for dually eligible MA enrollees compared to those enrolled in Medicare alone.

The AMA supports efforts to reduce prescription drug prices, lower out-of-pocket prescription drug costs, and increase drug pricing transparency. Therefore, the organization emphasized its support for the MOOP proposal and recommended that it is finalized.

MA plans must issue and reissue member identification cards that enrollees use to access covered services under the plan. Likewise, a Medicare Part D plan sponsor must issue a card for enrollees to use to access negotiated prices for covered Part D drugs.

The AMA stated that there should be improved transparency surrounding prescription drug costs, including rebate and discount information, financial incentive information, pharmacy and therapeutics (P&T) committee information, etc.

Therefore, the AMA encourages efforts to publish a Real-Time Prescription Benefit (RTPB) standard to meet the needs of all physicians and other prescribers. Both physicians and prescribers can utilize EHR records and other technology tools to boost overall communication and reduce the incidence of prescription abandonment.

"The AMA applauds CMS for streamlining the codification of member identification cards and ID card standards and supports providing additional information to beneficiaries concerning which pharmacies offer prescription drugs at a preferred cost," the organization stated.  

Lastly, the AMA letter includes support for CMS' proposal to help Medicare patients with their drug costs by including all pharmacy price concessions in the definition of "negotiated price." This initiative will help lower Medicare patients' cost-sharing for prescription drugs.

"We are pleased to see CMS taking action on this front and support the agency's proposal to ensure that all pharmacy price concessions, including retroactive direct and indirect remuneration fees, are included in the definition of 'negotiated price,'" the AMA stated.

"The proposed change to the definition of 'negotiated price' is significant, as the negotiated price in Part D is the cornerstone that determines beneficiary cost-sharing at the point of sale, as well as health plan and government liabilities," the organization concluded.