Proposed Rule Addresses Formulary Placement, Drug Negotiation & OOP Payment Plan

For contract year 2026, CMS hopes to ensure Part D plans’ formulary policies provide patients with access to generic and biosimilars, bolster transparency from plans and pharmacy benefit managers when they are working with contracted pharmacies, and add forms of dementia beyond Alzheimer’s to the condition list plans must use to identify beneficiaries with multiple chronic diseases, according to a proposed policy and technical changes rule for Medicare Advantage and Part D released Tuesday (Nov. 26). CMS is also proposing...