Category: Medicare Part D

February 7, 2020

ESRD Proposal May Inadequately Reimburse Medicare Advantage Plans

Medicare Advantage proponents are concerned that the new CMS proposal may result in underpayment to Medicare Advantage plans for end-stage renal disease care. While payers and Medicare Advantage proponents applauded elements of the Medicare Advantage rule that CMS proposed yesterday which will increase plans’ revenues by nearly one percent, many expressed concerns about the proposed rule’s approach to chronic disease management costs for patients with end-stage renal disease (ESRD).

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February 5, 2019

New Part D Opioid Overutilization Policies Call: 2/14/19

Date: Thursday, February 14, 2019

Time: 1:30 pm to 3 pm ET

Registration Link: Register for Medicare Learning Network events.

About the Event: CMS implemented new opioid policies for Medicare drug plans effective January 1. The new policies include:

Improved safety alerts when patients fill opioid prescriptions at the pharmacy
Drug management programs for patients at-risk for misuse or abuse of opioids or other drugs

During this call, CMS experts discuss the new policies and answer questions.

Prior to the call, participants should review the following materials:

Training materials, including slide decks and tip sheets for prescribers, pharmacists, and patients
A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 MLN Matters Article
Reducing Opioid Misuse webpage for more information on the CMS strategy

Target Audience: Physicians; physician assistants; nurses; nurse practitioners; dentists and other prescribers; case managers; and other interested stakeholders.

December 13, 2017

News for Your Patients: CMS Announces Improved Access to High-Quality Health Coverage Choices; Decreased Premiums for 2018

The Centers for Medicare & Medicaid Services (CMS) recently released 2018 benefit and premium information as well as Star Ratings for Medicare health and drug plans. Changes announced represent more health coverage choices, improved access to high-quality health choices, and decreased premiums in 2018. “Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma.

The following resources have been created to assist patients with understanding health coverage options:

2018 Medicare Parts A & B Premiums and Deductibles: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-17.html
2018 Medicare Advantage and Part D Star Ratings:http://go.cms.gov/partcanddstarratings
Medicare Advantage and Part D Prescription Drug Program: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-09-29.html
Prescription Drug Coverage: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html

For more information about the CMS health coverage announcement, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-10-11.html

For information on proposed policy changes and updates for Medicare Advantage and the Prescription Drug Benefit Program for 2019, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-16.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

November 8, 2017

Medicare Part D: Time to Review

Medicare offers prescription drug coverage to everyone with Medicare. If your patients decide not to get Medicare drug coverage when they are first eligible, they may be asked to pay a late enrollment penalty unless they have other creditable prescription drug coverage or are receiving Medicare’s Extra Help.

Every year, Medicare’s open enrollment period is October 15 – December 7. Medicare health and drug plans can make changes each year. These changes could affect the cost, coverage, and the providers and pharmacies in their networks. You can assist your patients by discussing their Medicare Part D coverage and timelines for the ESRD coordination of benefits period to ensure that they are prepared for the year to come.

To research Medicare drug plans use the Medicare Plan finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx

October 11, 2017

Encourage Your Patients to Review Their Options: Medicare Open Enrollment is October 15 – December 7

Helpful resources for your patients:

Visit https://www.medicare.gov/find-a-plan to compare current coverage with all of the options in the area.
Review the Medicare & You 2018 handbook at https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf.
Patients with limited income and resources may be able to get extra help paying prescription drug costs. For more information, visit https://secure.ssa.gov/i1020/start.
Get one-on-one help from the State Health Insurance Assistance Program (SHIP). Visit https://www.medicare.gov/contacts/.
In 2018, patients who reach the “donut hole” in Medicare’s prescription drug benefit (Part D) can save 60% on covered brand-name drugs and see increased savings on generic drugs while in the donut hole. Visit: https://www.medicare.gov/part-d/