The new rules would:
- Improve Medicare's Part D Coverage by expanding the number of drugs covered by the plan, including prescriptions used to treat anxiety disorders and seizures, as well as drugs for anesthesia under certain conditions.
- Allow physicians to request reconsiderations by an Independent Review Entity if prescriptions under a patient's Part D coverage are denied without requiring them to obtain a signed authorization form.
- Allow CMS to terminate poorly performing Medicare Advantage and Part D sponsors that have failed to receive a three-star rating from CMS over a three-year period.
- Expand benefits and increase flexibility for those receiving both Medicare and Medicaid, allowing such individuals to access supplemental benefits like non-skilled nursing activities in the home and in-home food delivery for those eligible.
- Streamline claims' filing to prevent fraud. Pharmacy benefit managers would be required to provide additional financial information to increase transparency, which would allow for improved data collection and enable law enforcement to more easily investigate suspected fraud.