
5 Things About CMS' Finalized Policies for 2019
On Monday, CMS announced that it has finalized policies for Medicare health and drug plans for 2019 aimed to lower the cost of drugs for beneficiaries and provide additional plan choices.
On Monday,
1. Tackling prescription drug prices
As prescription
Other initiatives include allowing certain low-cost generic drugs to be substituted onto plan formularies any point during the year. To promote competition among plans, the agency is removing the requirement that certain Part D plans have to “meaningfully differ” from each other, which they say will make more plan options available. Among pharmacies, CMS says they will clarify the “any willing provider” requirement to increase the number of pharmacy options beneficiaries have to choose from.
2. Expanding the definition of “primarily health-related”
CMS is reinterpreting the standards for health-related supplemental benefits for Medicare Advantage plans to include additional services that increase health and improve quality of life. Under the new definition, the agency will allow supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”
While many Medicare Advantage plans
3. Opening the door for vendors such as Amazon and Walmart to work with health insurers
CMS’ new rules for Medicare Advantage plans could have far-reaching effects, according to an article in
This could also translate into new partnerships with companies, such as Amazon and Walmart, that have not historically been involved in health-related services.
4. Addressing the opioid epidemic
Amid nationwide efforts to combat the opioid epidemic, CMS said they are finalizing policies that respond to growing calls to address the epidemic. According to CMS, the policies provide Medicare with additional tools to combat opioid overprescribing and abuse, as well as protect families and communities nationwide.
Among these policies is a new authority that permits Part D sponsors to
5. Patients Over Paperwork initiative
The final policies also include an advancement to the “Patients Over Paperwork” initiative. The initiative works to remove regulatory obstacles and empower patients to make informed healthcare decisions; develop innovative approaches to improving quality, accessibility, and affordability; and improve beneficiaries’ customer experience.
According to CMS, the final policies will allow the agency to use notice of electronic posting to fulfill disclosure requirements for certain bulky documents and streamline government review and approval of marketing materials Medicare health and drug plans use. Increasing the weight given to patient experience and access measures, the agency will improve transparency of the Star Ratings that provide beneficiaries information about each Medicare Advantage and Part D plan’s quality rating.
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