CMS Hikes Medicare Advantage Plan Payments, Finalizes New Drug Rules
The agency will also give Part D plans the ability to create a "preferred" specialty tier of high-cost drugs with lower cost-sharing for enrollees by Jan. 1, 2022. That change could mean lower prices for expensive medications, Modern Healthcare reports.
Modern Healthcare:
CMS Will Raise Medicare Advantage Plan Payments By 4.08% In 2022
CMS will raise Medicare Advantage plan payments by 4.08%, the agency announced Friday. It also signed off on its controversial proposal to complete a multiyear phase-in of a new payment methodology. The new process will adjust plan payments using diagnoses solely from encounter data—information created by healthcare providers about patients' medical conditions and treatment. The health insurance industry has long railed against the use of encounter data to adjust their payments. They argue that the data is incomplete and often inaccurate and that using it would lead to lower payments to Advantage plans. (Brady, 1/15)
Modern Healthcare:
CMS Finalizes Drug Transparency, Pharmacy Quality Rules
CMS on Friday finalized a rule it estimates will save the federal government $75.4 million over the next decade in Medicare Advantage and Part D payments, with the agency crediting cost-savings to several measures enacted to curb prescription drug spending. Under the new rule, CMS expanded drug and medication therapy management programs that require Medicare Part D plans to review potentially-risky opioid use trends with providers and patients. The final law also requires Medicare Part D sponsors to report payment suspensions against pharmacies facing fraud allegations to CMS, falling in line with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act. The legislation also mandated Medicare Advantage and Part D plan sponsors report inappropriate opioid prescriptions and insurers' actions to CMS via a secure internet portal. (Tepper, 1/15)
In other news about the price of medications —
Stat:
Maryland Senate Overrides Governor's Veto Of Medicine Affordability Board
In response to the rising cost of medicines, the Maryland state Senate overrode a veto issued last year by Gov. Larry Hogan, who objected to funding a so-called ‘Prescription Drug Affordability Board.’ The board was created two years ago to establish maximum prices that the state and local governments will pay for “high-cost” medicines. (Silverman, 1/15)
KHN:
‘An Arm And A Leg’: Host Dan Weissmann Talks Price Transparency On ‘Axios Today’
As we settle into the new year, we have two small doses of good news. First, a new federal rule could help cut through one health care issue. Host Dan Weissmann talked about the rule — which requires hospitals to make public the prices they negotiate with insurers — in a short conversation with his former public-radio colleague, Niala Boodhoo, for the daily-news podcast “Axios Today.” (Weissmann, 1/19)
