The CMS Final Rule on Best Price Calculations and How We Can Help


On Monday, December 21, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a final rule obligating pharmaceutical manufacturers to ensure that the full benefit from patient assistance programs goes directly to patients. Otherwise, manufacturers must report patient assistance that does not go exclusively to patients in their best price calculations. This rule goes into effect on January 1, 2023.

How does this impact you, our customers?

In the past, patient assistance has been excluded from best price calculations. However, this rule further clarified that manufacturers must not only ensure patients exclusively benefit but that manufacturers are now responsible for implementing systems to prevent insurers or other third parties from receiving a financial benefit (if such amounts are to be excluded from best price calculations).

ConnectiveRx can help.

We are the leading provider of solutions that help ensure that patients directly benefit from patient assistance programs. In fact, as the pioneers of copay and solutions that help address the impact of accumulator programs, we’ve been helping our customers by designing effective programs for years. As your partner, we will help you navigate this shifting landscape and better support your patients (and your bottom line).

Our take.

Helping patients better afford their prescriptions is what we all strive to do. We know that patients can’t benefit from medications that they can’t afford, and this rule will help enable patients to directly benefit from the payment assistance programs that manufacturers provide.

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