Call Centers Beware

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On May 10, 2019, CMS published a final rule on Drug Pricing Transparency. The rule, effective July 9, 2019, requires direct-to-consumer television advertisements of prescription drugs and biological products payable by Medicare or Medicaid to include the Wholesale Acquisition Cost, otherwise known as the “list price”, of such drug or product. Although the rule requires such television advertisements to contain a statement that if health insurances covers the cost of the drug, the cost charged to the beneficiary may be different from the list price, some level of member confusion is still expected. This member confusion is likely to result in increased call volume to Plans and PBMs once advertisements complying with the new rule begin in July.  Make sure your call center knows about this final rule and is prepared for these member calls through scripts and training.  Your grievances department should also be prepared for potential volume increases if members express dissatisfaction with the Plan’s prescription drug price(s).