- Center on Health Equity and Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
CMS Proposal Would Modify Medicare Part D
A Centers for Medicare & Medicaid Services (CMS) proposal would remove a number of prescription drug classes from Medicare Part D drug plans, while also limiting the number of plans insurers could offer to seniors.
A Centers for Medicare & Medicaid Services (CMS) proposal would remove a number of prescription drug classes from Medicare Part D drug plans, while also limiting the number of plans insurers could offer to seniors. Although current Part D plans cover a variety of medications in 6 “protected” classes, CMS’s proposal would cut at least 2 of those protected classes in 2014, and potentially another in 2015. Those set for removal include prescription antidepressants, immunosuppressants, and antipsychotics. Many advocate groups worry that the proposal would limit patients’ access to the medications they’ve always had through their traditional Part D plans.
“The CMS administrators have said, ‘We don’t have any problems with the other drugs that aren’t in these protective classes,’ as they call them,” said Emily Ethridge of CQ Roll Call. “There are about 140 classes of drugs that Medicare has on its formulary plan. And there are only 6 that are in the ‘special’ categories. They’re saying ‘If you don’t have a problem with the other 134, we shouldn’t have any problems with a couple of these.’”
CMS administrators further voice concern over the oversaturation of plans in the marketplace. This can confuse senior citizens who, when faced with too much information and too many choices, will simply stick with 1 plan and not seek alternative options. The thought is that narrower offerings will make it easier for seniors to make better decisions about their health coverage.
“We heard a lot from the CMS officials about price and the cost of Medicare Part D, which covers prescription drugs. It’s increasing much higher than the rest of Medicare. They say this proposed rule would actually save money over 10 years. And they say it would make things simpler for seniors,” Ms Ethridge adds. “The healthcare law is reducing that prescription drug doughnut hole, that coverage gap that we’ve all heard so much about. If that’s being made smaller, then we don’t need all these plans to fill that in—we don’t need all these choices, and we don’t need to spend money on all of these options. It’s just not necessary.”
Around the Web
How Proposed Part D Changes Are Playing On Capitol Hill [Kaiser Health News]
Prices for care at hospital trauma centers vary across hospitals; drug shortages reached a record high during the first quarter of 2024; although 3 of the biggest makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35, these do not apply to daily inhalers used by the youngest kids with asthma.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
The Biden administration recently launched the Global Health Security Strategy, a new effort to combat the spread of infectious diseases; lawmakers zeroed in on the risks of massive consolidation in health care during the first congressional hearing on the Change Healthcare hack; the FDA recently announced the recall of a pair of heart devices linked to numerous deaths and injuries.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
