PAN joins letter urging Centers for Medicare & Medicaid Services to protect patients from Part D plan utilization management practices in 2025
The PAN Foundation joined a letter from dozens of patient advocacy and healthcare organizations urging the Centers for Medicare & Medicaid Services (CMS) to take action to increase transparency regarding the use of utilization management practices by Medicare Part D prescription drug plans to support and protect patients. Utilization management practices, which limit the plan’s expenditures, include tools such as step therapy (or “fail first” policies), prior authorizations, refill limits, and changes in formularies. Increased use of utilization management practices restricts patient access to therapies and increases out-of-pocket costs for those plans’ beneficiaries.
As the Medicare Part D benefit design changes are implemented in 2025, Part D plans will see an increase in their liability for drug expenditures in the catastrophic phase of coverage. Plans will now be responsible for 60% of costs in the catastrophic phase, an increase from 15% in 2023. The organizations included in this letter express concern that Part D plans will pass on these costs to patients and urge CMS to protect patients by educating beneficiaries about potential changes in utilization management practices and to monitor changes in formulary design.