Tuesday , June 15 2021

CMS pauses organ procurement, Part D e-prescribing rules

The Biden administration on Friday paused two Trump-era regulations affecting organ procurement organizations and Part D prescription drug plans.

CMS delayed a rule that would revamp quality reporting measures to boost transparency in the organ procurement and transplantation process, according to the agency. It also pushed back a rule that would mandate Part D plans to support a new electronic prior authorization standard for their Part D e-prescribing plans. Both regulations were set to take effect on Feb. 1 but will now start on Mar. 30.

It’s unclear whether the Biden administration will ultimately move forward with either rule.

The OPO rule would create two new objective measures designed to encourage such organizations to use all available organs and transplant them. One measure would monitor the number of organs an OPO has gotten from eligible donors in its donation service area. The other would evaluate the transplantation rate instead of organ procurement alone. The previous measures created a disincentive to go after all available organs. Under the new rule, underperforming OPOs would compete for their contracts, and the worst performers would be unable to renew their contracts.

The new prior authorization rule is supposed to enable providers to see whether a drug requires prior authorization when prescribed, helping patients avoid delays when they pick up their prescriptions. About 70% of pharmacy benefit managers have already implemented the “Script” standard developed by the National Council for Prescription Drug Programs. The new rule would make the standard universal. But some experts worry it would limit future innovation because it wouldn’t allow for other approaches.

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