CAHC Scores Win for Transparency in Final CMS Rule

Rule heeds coalition's call for expanded use of real-time benefit tools to help patients and providers identify cost-effective treatment options 

WASHINGTON, DC (May 16, 2019): The Council for Affordable Health Coverage (CAHC)  – a coalition of employers, insurers, life science companies, PBMs, brokers, agents, patient groups, and physician organizations – responded today to release of a final rule from the Centers for Medicare and Medicaid Services (CMS) modernizing the Medicare Part D and Medicare Advantage programs. 

The rule includes provisions long championed by CAHC requiring Part D plans to implement an electronic real-time benefit tool (RTBT) that integrates with doctors' prescribing systems or electronic health records. This would allow patients to understand their out-of-pocket costs for a medication before arriving at the pharmacy counter and, if necessary, pursue lower-cost treatment options in consultation with their doctor. 

CAHC President Joel White released the following statement: 

"Price transparency at the point of prescribing is largely missing from the healthcare equation. Real-time benefit tools are a disruptive force that can fix that disparity. We are glad to see the administration heeding CAHC's calls for expanded use of this innovation," said CAHC President Joel White. "When patients know their out-of-pocket costs for a medication upfront, before leaving the doctor's office, they can discuss their options with their provider, avoid unpleasant surprises at the pharmacy counter, and are more likely to remain adherent to their prescribed treatment." 

White concluded, "While this does not remove the pressing need for Congressional action, the RTBT provisions in this final rule will go a long way toward better informing and empowering patients - a key step toward bolstering competition and lowering drug costs. We applaud Secretary Azar and the administration for this bold action." 

CAHC briefed Congressional aides on the benefits of RTBTs just last week, where it also unveiled a new report calling upon Congress to put this technology to use in Medicare Part D and Medicare Advantage plans. 

Read more about CAHC's work to improve prescription drug affordability and access at