Medicare Advantage, Part D Programs Finalized for Next Year

Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Advantage and Part D Prescription Drug Programs for 2018. Through the latest round of updates, CMS aims to support flexibility and efficiency that allows enrollees to choose the most beneficial care plan for their individual needs, according to a press release.

The final policies are similar to those proposed in February, but underwent changes that were discussed during the public comment period.

The plans should see a revenue change of 0.45% on average, but the CMS advises that individual experiences may be different. Additionally, plans should expect a change of 2.95% in revenue when calculating expected growth in coding acuity.

However, plans that substantially improve care will see higher updates and can improve the benefits offered to enrollees, according to the release.

The revised policies provide flexibility and incentives for insurers to create plan options that include innovative provider networks that encourage enrollees to use high-quality services. CMS stated that the policies will increase the variety of Medicare Advantage and Part D plans offered to enrollees in 2018.

CMS is also working to finalize policies that combat opioid overuse by encouraging safeguards prior to dispensing, but will preserve access to needed prescription drugs. The agency noted that plan sponsors, along with prescribers, can better identify best practices and appropriate care management for enrollees treated with opioids.

Under the proposed opioid policy, Part D sponsors are expected to focus on improving coordinated care among enrollees prescribed opioids, while Medicare Advantage plans that include drug coverage should consider expanding care management services, according to the release.

In addition to policy updates, the CMS is also calling for feedback on Medicare Advantage and Part D regarding ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to increase transparency, flexibility, program simplification, and innovation, according to the release.

“Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” said Seema Verma, MPH, CMS administrator. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”