On November 16, 2017, the Centers for Medicare & Medicaid Services(“CMS”) published for public inspection a proposed rule that would impact a variety of Medicare Part C and Part D program provisions. The proposed rule, Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program,(the “Proposed Rule”) was published in the Federal Register on November 28, 2017. Those interested in submitting comments to the Proposed Rulemust do so by January 16, 2018.

CMS touts the Proposed Rule as “promoting innovation and empoweringb [Medicare Advantage] and Part D sponsors with new tools to improve quality of care and provide more plan choices” for Medicare beneficiaries. TheAgency also intends to generate drug cost savings for plan enrollees and the Medicare program through its proposed changes. CMS seeks to achieve these goals through a variety of measures, including soliciting comment onpotential means by which pharmacy benefit managers (“PBMs”) could pass rebates through to enrollees at point of sale, proposing to eliminate or soften the “meaningful difference” requirement that limits the variety of plans a Medicare Advantage (“MA”) organization can offer, and offering increased flexibility with regard to the uniformity of benefits that must be offered to MA enrollees. CMS also proposes a number of other measures to ease regulatory constraints on Medicare Advantage and Part D plans, such as

amending the definition of marketing to reduce the burden of agency review, providing for default and passive enrollment of certain MA and dually eligible beneficiaries, and revising enrollee appeal rights related to Part D tiering to ameliorate access concerns created by increasing numbers of pharmacy tiers. Also incorporated in the Proposed Rule are important updates to Part D requirements imposed by the 2016 Comprehensive Addiction and Recovery Act (“CARA”) to combat opioid abuse.