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2020 MIPS IA_BE_25: Drug Cost Transparency

Activity ID

IA_BE_25

Activity Weighting

High

Subcategory Name

Beneficiary Engagement

Activity Description

To receive credit for this improvement activity, MIPS eligible clinicians must attest that their practice provides counseling to patients and/or their caregivers about the costs of drugs and the patients’ out-of-pocket costs for the drugs. If appropriate, the clinician must also explore with their patients the availability of alternative drugs and patients’ eligibility for patient assistance programs that provide free medications to people who cannot afford to buy their medicine. One source of information for pricing of pharmaceuticals could be a real-time benefit tool (RTBT), which provides to the prescriber, real-time patient-specific formulary and benefit information for drugs, including cost-sharing for a beneficiary. (CMS finalized in the Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses final rule (84 FR 23832, 23883) that beginning January 1, 2021 Medicare Part D plans will be required to implement one or more RTBT(s).)

Validation

MIPS eligible clinicians and groups will provide counseling to patients and/or their caregivers regarding the cost of drugs and the patients’ out-of-pocket expenses related to their prescribed medications. When applicable, the MIPS eligible clinician or group must discuss with patients the availability of alternative drugs and the patients’ eligibility for patient assistance programs that provide free medications for patients that are unable to afford to buy their medicine, i.e. real-time benefit tool (RTBT).

Suggested Documentation

1) Documentation could include an EHR note that the MIPS eligible clinician provided counseling to patients and/or caregivers about the costs of drugs including the patient’s out-of-pocket costs for the drugs; and/or
2) The MIPS eligible clinician or group must demonstrate with documentation within the RTBT or EHR that a discussion/counseling regarding the availability of alternative drugs, and (when applicable) a patient’s eligibility for patient assistance programs that provide free medications for patients occurred.

NOTE: For the purposes of this IA, patient assistance programs pertain to financially needy patients that require assistance to purchase necessary medications, i.e. www.rxassist.org/providers. Additional information pertaining to real-time benefit checks and its impact on patient care can be reviewed here: www.covermymeds.com/main/insights/rtbc-scorecard/ (CMS finalized in the Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses final rule (84 FR 23832, 23883) that beginning January 1, 2021 Medicare Part D plans will be required to implement one or more RTBT(s).

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