Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare Part D

Private Medicare Advantage Plans Receive Marketing Boost from DC

December 4, 2018 - While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times. With the open enrollment period for the plan ending last Friday, federal officials predict that almost 37 percent of the 60 million Medicare beneficiaries will be in Medicare Advantage plans...


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Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

by Kyle Murphy, PhD

CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

CVS-Aetna Merger Now Expected to Close After Thanksgiving

by Kyle Murphy, PhD

Close to a year has passed since CVS Health announced its plan to acquire Aetna in a $69-billion acquisition. Now only the approval of two state departments of insurance stands in its way. In a recent filing to the Securities and Exchange...

AMA Expresses Concern with Medicare Part D Formulary Changes

by Thomas Beaton

New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to HealthPayerIntelligence.com. In an emailed...

CMS Adds Flexibility to Medicare Part D Formulary Strategies

by Thomas Beaton

CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice. A memo from the agency highlights a major upcoming change to the...

Medicare Advantage Part B Plans Can Use Drug Step Therapy

by Thomas Beaton

CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered...

AMA: CVS-Aetna Merger Would Reduce PBM Competition, Raise Prices

by Jennifer Bresnick

The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.  The combined entity would drastically reduce competition in many pharmacy benefit management (PBM)...

Medicare Part D Premiums Expected to Decline in 2019

by Thomas Beaton

CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect. Earlier in 2018, CMS issued a final rule that made...

Generic Drugs Could Have Saved $3B for Medicare Part D Program

by Thomas Beaton

Using generic drugs instead of their brand-name equivalents could have saved the Medicare Part D program approximately $3 billion in 2016 alone, according to new data from HHS. A relatively small number of brand-name therapies is...

CMS Highlights Drug Price Transparency Data Dashboards

by Thomas Beaton

CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

by Thomas Beaton

Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience...

CMS Releases Proposed Medicare Advantage, Part D Changes

by Thomas Beaton

CMS has released the second part of its proposed Medicare Advantage (MA) and Medicare Part D changes, which include administrative upgrades to assist with combating the nation’s the opioid crisis and allowing payers to incorporate...

Medicare Advantage, Part D Updates to Shift Control to Health Plans

by Thomas Beaton

CMS is proposing regulatory changes that would offer health plans additional flexibility to design and implement Medicare Advantage (MA) and Part D Medicare benefits.   The rule would reduce administrative burdens by allowing plans...

Employers Must Prepare Retirees for $275K in Expected Care Costs

by Thomas Beaton

Employers are starting to prepare and educate retirees for expected post-retirement care costs of $275,000, according to market analysis published by Fidelity Investments. The analysis found a 6-percent increase in costs over a similar...

Payers May Be Neglecting a Growing Medicare Advantage Market

by Thomas Beaton

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power...

Increasing Competition Can Reduce Prescription Drug Prices

by Thomas Beaton

Reducing prescription drug prices for payers requires market-based solutions that increase competition and deregulate federal drug policies, the Pharmaceutical Care Management Association (PCMA) wrote in a letter to HHS secretary Tom...

Cigna Re-enters Medicare Advantage Market With CMS Approval

by Jesse Migneault

Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

by Thomas Beaton

CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue...

AHA Questions CMS Medicare Advantage Risk Score Calculation

by Kyle Murphy, PhD

The American Hospital Association (AHA) has voiced concerns about the methodology the Centers for Medicare & Medicaid Services (CMS) intends to use to calculate risk scores for health plans under the Medicare Advantage and Part D...

Top 3 Health Insurance Industry Headlines of December 2016

by Vera Gruessner

Now that the final month of the year is wrapping up and everyone is planning their New Year’s celebrations, a review of the most popular headlines for the health insurance industry may be beneficial as we head into 2017. Patients...

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