CMS has released a proposed rule concerning several administrative and technical changes to Medicare Advantage (MA) and Medicare Part D plans. Many of the changes were mandated by the Bipartisan Budget Act of 2018 (BBA), while others are intended to reduce administrative burden on providers, plans, and beneficiaries. The rule will appear in the November [...] Read More
In the Bipartisan Budget Act of 2018 the Congressional Budget Office underestimated – by $4 billion – the amount Medicare would save due to changes in Medicare Part D. Instead of saving $7.7 billion, Medicare will actually save $11.8 billion. The savings come from an increase in the government mandated discount that drug manufacturers must offer enrollees [...] Read More
Here are some reimbursement related reasons why access to biosimilars has been slower than hoped, even though patient out-of-pocket costs are lower. Current System Is an Improvement Over Earlier System, But Could Be Better Part B Is For Biologics (and Some Drugs) When I was working at the Senate Legislative Counsel’s office drafting the Average [...] Read More
This evening, the Medicare Board of Trustees released their annual report on the status of two separate trust funds, the Hospital Insurance (HI) Trust Fund and the Supplementary Insurance (SMI) Trust Fund. The Boards of Trustee report annually on the financial operations and actuarial status of the program in a combined report that covers Medicare […]
Read MorePresident Trump has released his long-awaited plan to address prescription drug prices, the mysterious contents of which have been causing heartburn for manufacturers, pharmacy benefit managers (PBMs), health plans, and other stakeholders for several weeks. The consensus seemed to be that manufacturers and PBMs were likely to have large targets on their backs. On the […]
Read MoreOn April 2, 2018, the Center for Medicare and Medicaid Services (CMS) released a pre-publication version of a final regulation impacting both the Medicare Advantage (MA) and Medicare Part D prescription drug benefit programs. The provisions of the rule will be effective for the 2019 plan year. Update: CMS released the final version of the […]
Read MoreOn April 2, 2018 CMS released the final CY 2019 Call Letter for Medicare Advantage (MA) and Medicare Part D plans. There were no substantial changes to the proposals included in the draft Call Letter, which were finalized generally as proposed. However, the agency did have to update the Standard Benefit Parameters to reflect the […]
Read MoreOn February 1, 2018 CMS released the CY 2019 draft Call Letter for Medicare Advantage (MA) and Medicare Part D plans. CMS states that the updates made will continue to create more choices for Medicare beneficiaries that choose MA and Part D plans in 2019. CMS is accepting comments through March 5, 2018. The final […]
Read MoreOn January 11-12, 2018, the Medicare Payment Advisory Commission (MedPAC) held the next meeting of their current term and their first meeting of the new year. At the meeting, commissioners spent a significant portion of the meeting discussing Medicare Part D, Medicare Advantage, and the Merit-based Incentive Payment System (MIPS). Additionally, the commission conducted its […]
Read MoreFor the first time in three years, CMS has proposed a formal regulation concerning the Medicare Advantage (MA) and Medicare Part D prescription drug benefit programs. Typically, the agency has managed both benefits via the annual Call Letter process, which is subregulatory guidance. The proposed rule garnered a lot of speculation while it was under […]
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