Medicare Part D

On November 6, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Part D, Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. The proposed rule aims to strengthen beneficiary protections and guardrails to promote healthy competition and ensure MA plans best meet the needs of beneficiaries. It seeks to increase the percentage of dually eligible individuals enrolled in managed care who receive both Medicare and Medicaid services through the same organization...

The Centers for Medicare & Medicaid Services (CMS) recently announced the first 10 drugs covered under the Medicare Part D prescription drug benefit selected for negotiation. As a result of the Inflation Reduction Act (P.L. 117-169), Medicare, for the first time, has the ability to directly negotiate prices of certain high expenditure, single source drugs without generic or biosimilar competition, based on total gross covered prescription drug costs under Medicare Part D and other criteria as required by the law. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. The negotiation process will consider the selected drug’s clinical benefit...

CMS projects the calendar year 2024 average total monthly premium for Medicare Part D prescription drug coverage to be $55.40; a decrease of 1.8 percent from 2023. The average total Part D premium is the sum of the average basic premium and the average supplemental premium for plans with enhanced coverage. CMS reports that the projected decrease in the average total Part D premium is due to a limit in the growth of the base beneficiary premium to an annual six percent increase and other changes to the Part D benefit in 2024 as specified by the Inflation Reduction Act. Additionally, in 2024 CMS’ Part D pharmacy price concessions policy is expected to reduce beneficiary out-of-pocket costs by requiring Part D plans to apply all price...

On July 12, the Kaiser Family Foundation (KFF) released an issue brief describing high-cost drugs which accounted for a disproportionate share of Medicare spending. As required under the Inflation Reduction Act, the federal government will announce 10 Medicare Part D prescription drugs by September 1, 2023, selected for price negotiations in 2026. To provide an understanding of the potential impact of negotiating prices, KFF’s analysis found that Medicare Part D spending was concentrated among a small number of prescription drugs, and ten top-selling Medicare-covered prescription drugs in 2021 accounted for 22 percent or nearly one-fourth of gross Part D spending....

This technical assistance tool focuses on the new “information sharing” requirement for Dual Eligible Special Needs Plans beginning in 2021. The tool explains the new requirement as well as how to address the requirement in mandatory D-SNP contracts.

According to this data brief from the OIG, prescriptions used to treat opioid addiction have increased in recent years. At the same time, prescriptions for opioid painkillers have decreased. These positive results demonstrate the value of awareness, drug treatment, and law enforcement efforts in addressing the crisis.

On Friday, July 15, 2016, the Centers for Medicare & Medicaid Services (CMS) published an informational bulletin to provide an update on the next steps for the annual redetermination of Medicare Part D low-income subsidy (LIS) deemed status, also known as “re-deeming.” The information provided is aimed to help states understand the process and their role in ensuring that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under Medicare Part D.