Breast Cancer, HIV Drugs May Face Tougher Part D Climate Under Protected Class Proposal
Medicare proposed rule exposes Part D protected class drugs to threat of formulary exclusion if price increases exceed a certain threshold. Here's how it might play out for cancer and HIV drugs.
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CMS proposed rule would not eliminate any protected classes but would allow plans to impose additional restrictions on drugs in those classes. Proposal also codifies step therapy for Part B drugs.
The early February date for publishing the list of products eligible for price negotiations could dictate approval strategies for drugs with potential for big sales in Medicare going forward.
Increased application of utilization management controls expected as plans face higher costs under the redesign. However, the formulary advantages available to drugs in the protected classes may lead developers to sharpen their focus on those categories.