New MA Rule Touches Protected Classes, Imposes Pricing Tool - Radar Medicare Advantage

Michael Strazzella, Federal Government Relations practice group leader, comments on CMS' proposed rule to make changes to the Medicare Advantage and Part D programs in an effort to control drug prices in Radar Medicare Advantage's article "New MA Rule Touches Protected Classes, Imposes Pricing Tool."

"I think being able to exclude [certain] protected class drugs from the formulary is going to be very significant for plans. That they can exclude a drug just because it's made a minimal change to an older drug, even one that's still on the market, is huge. And it is going to force the pharmaceutical companies to work more within the formulary managed care communication," remarked Michael Strazzella, practice group leader for federal government relations and administrative head of the Washington D.C., law office of Buchanan, Ingersoll & Rooney. "Of course, the pharmaceutical lobby is not happy with it, but there are so many players and you're never going to make one player happy."

"I think it's going to be very interesting if they decide to try and move forward with the tool," says Strazzella. "Information doesn't hurt decisions, but whether it gets utilized or not is unclear to me. And if medical decisions are going to be totally based on pricing, that's a dangerous way to go." And it would require "constant monitoring" and additional education to providers, which could be challenging, he adds.