CMS Releases RFI on Medicare $2 Drug List Model

Health Highlights

October 16, 2024

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On October 9, the CMS published a Request for Information (RFI) on its proposed Medicare $2 Drug List Model. This model was first previewed in a February 2023 report from Department of Health and Human Services (HHS) Secretary, Xavier Becerra, in response to President Biden’s October 2022 Executive Order on Lowering Prescription Drug Costs for Americans, which directed the Secretary to “consider whether to select for testing by [the Center for Medicare and Medicaid Innovation (CMMI)] new health care payment and delivery models that would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs.”

Under this voluntary model that could start as early as 2027, participating Part D plans would offer a standardized set of low-cost generic drugs as part of their basic benefit package at a fixed copayment of up to $2 for a month’s supply (and up to $5 for a three-month supply), applied across all phases of Part D coverage up to the out-of-pocket limit ($2,000 in 2025). Drugs covered under the model target conditions common among Medicare beneficiaries and would not be subject to utilization management requirements. By standardizing cost sharing across participating plans, the model aims to encourage uptake of generic drugs by making them more affordable and addressing uncertainty beneficiaries and providers face in assessing out-of-pocket costs prior to filling a prescription.  

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