On Nov. 30, AMCP submitted comments on CMS draft guidance for Calendar Year (CY) 2022 Medicare Advantage capitation rate and Part C and Part D payment policies. AMCP responded to CMS’s proposed introduction of a COVID-19 measure for the 2023 Part C and Part D performance measure display page and in the Star Ratings program, pending rulemaking.
On November 20, HHS released a Final Rule that amends the discount safe harbor regulation to eliminate protections for price concessions offered by pharmaceutical manufacturers to plan sponsors and pharmacy benefit managers (PBMs) under contract with plan sponsors starting January 1, 2022.
On November 20, HHS released an Interim Final Rule with Comment Period (IFC) establishing a Most Favored Nation (MFN) Model for Medicare Part B drugs. The MFN Model will calculate the payment rate for included drugs based on a price that reflects the lowest per capita GDP-adjusted price among a group of OECD countries, with an additional flat payment based on the average payment for MFN Model drugs in 2019 adjusted quarterly for inflation.