CMS Reverses Recent Demonstration Plan That Would Have Allowed Part D Plans to Waive Protected Class and Formulary Requirements in 2022


CMS announced updates to the Part D Payment Modernization Model Calendar Year 2022 (PDM Model), reversing changes that were implemented in the final days of the Trump Administration. The PDM Model would have removed important protections for drugs in the six protected classes, such as allowing plans that participate in the model to treat five out of the six protected classes the same as any other Part D drug class and cover only one drug per class instead of two. Therefore, patients on anticonvulsants, immunosuppressants, antidepressants, antipsychotics, and antineoplastics could have faced nonmedical switching if their Part D provider was selected for participation in the model. Nonmedical switching can result in both negative health outcomes for patients and increased spending by plans, as stable patients may require additional treatment if their new medication is not as effective as their previous prescription. By removing the proposed flexibilities, CMS has ensured that patients retain important and long-running protections in their Part D coverage. Read the full summary of changes here.


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