On February 14, the U.S. Department of Health and Human Services (HHS) announced that the HHS Secretary had selected three new payment and service delivery models for testing by the Center for Medicare & Medicaid Innovation (CMS Innovation Center). HHS has directed the CMS Innovation Center to test whether these new models result in lower prescription drug costs, promote accessibility to therapies, and/or improve quality of care. This announcement is in response to President Joe Biden’s October 2022 Executive Order 14087, “Lowering Prescription Drug Costs for Americans,” which directs the Secretary of HHS to consider testing new health care payment and delivery models “that would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs, including models that may lead to lower cost-sharing for commonly used drugs and support value-based payment that promotes high-quality care.”
The selected models, which incorporate input from experts within CMS, other federal agencies, and over 40 external stakeholders, target outcomes-based arrangements for cell and gene therapies under state Medicaid programs, payment policies for accelerated approval drugs under Medicare Part B, and possible offerings for low, fixed copayments across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs.
The Secretary outlined these models in a Report, as described below. Details on each model are limited at this time. Interested stakeholders should monitor for additional guidance and any comment opportunities.
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