PCMA recently provided several recommendations to the Department of Health & Human Services (HHS) that would streamline and simplify requirements for Medicare Advantage and Part D plans, reducing administrative burdens and costs to both plans and patients.

Many recently expanded plan requirements have not led to increased effectiveness or efficiency, nor have they improved affordability, adherence, or health outcomes for patients. By streamlining requirements, HHS has an opportunity to reduce costs that are borne by the government, Medicare beneficiaries, and American taxpayers.

The full list of recommendations submitted to HHS can be accessed HERE. Key recommendations from PCMA include:

• CMS should rescind the 2024 final rule’s expansion of the MTM program pending further assessment of the program.
• CMS should redefine how it interprets “incurred costs,” under the IRA statute, to exclude supplemental benefit for the purposes of calculating a beneficiary’s true out-of-pocket costs (TrOOP).
• HHS should align guidance across its agencies and those of other federal departments to minimize compliance costs.
• CMS should withdraw the information collection request for MAO utilization management and revise it to reduce the burden on plan sponsors before re-issuing it.
• CMS should provide plans with more flexibility to produce and tailor required documents, including allowing for electronic delivery as a default.
• CMS, DOL, and DOT should revise transparency and reporting requirements to ensure that they are meaningful to consumers and do not undermine competition.

By simplifying regulations and setting clear requirements, HHS can promote competition in the market and foster even greater innovation to meet evolving patient needs.

PBMs are leaders in innovation, with the flexibility to adapt to changing market conditions by launching innovative programs that provide patients with a better experience accessing their prescription drugs. As drug companies continue to set and increase exorbitant prices for prescription drugs, PBMs are more valuable than ever to patients and payers. Recently, PBMs across the industry, from big to small, have rolled out new, innovative programs to help plan sponsors tackle high drug costs, allowing patients to access the drugs they need.

Learn more about innovations in the PBM market HERE.

Read the full letter that PCMA submitted to HHS HERE.

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