Medicare Part D

Payers react to 2025 Medicare Advantage, Part D Final Rates

April 10, 2024 - Payer trade organizations responded negatively to the 2025 Medicare Advantage and Part D Final Rate Notice, citing rising healthcare costs. “The CMS Final Rate Notice failed to address the concerns of influential bipartisan Members of Congress, thousands of Medicare Advantage beneficiaries, and more than one hundred organizations serving...

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Medicare Advantage final rule addresses competition and marketing practices

by Victoria Bailey

CMS has finalized policies to promote competition in Medicare Advantage and Part D plans, boost access to behavioral healthcare services, and reduce deceptive marketing practices. The Contract Year...

2024 Medicare Advantage premiums remain low and stable

by Victoria Bailey

The average Medicare Advantage premium has remained low and stable, with many beneficiaries choosing plans with a zero-dollar monthly premium, according to data from eHealth, Inc. eHealth’s...

Utilization Restrictions on Medicare Part D Drugs Increased, Study Finds

by Victoria Bailey

Utilization restrictions on Medicare Part D drugs, including prior authorization and formulary restrictions, increased over time between 2011 and 2020, according to a Health Affairs study. Pharmacy...

Medicare Part D Low-Income Subsidy Loss Tied to Higher Out-of-Pocket Costs

by Victoria Bailey

Beneficiaries who temporarily lost their Medicare Part D low-income subsidy experienced higher out-of-pocket drug costs and fewer prescription fills, a study published in JAMA Health Forum...

Drug Price Negotiation Would’ve Reduced Prices, OOP Spending in 2021

by Victoria Bailey

If the drug price negotiation program had been in effect in 2021, Part D drug prices would have fallen 63 percent and out-of-pocket spending would have declined 23 percent, research from Mathematica...

Medicare Advantage Star Ratings Fall for Second Consecutive Year

by Victoria Bailey

The average star ratings for Medicare Advantage and Medicare Part D prescription drug plans fell for the second year in a row to 4.04 and 3.11 stars, respectively, CMS data revealed. The star rating...

CMS: Medicare Advantage Premiums Will See Little Change in 2024

by Victoria Bailey

Ahead of the Medicare Open Enrollment Period, CMS has announced that Medicare Advantage premiums, benefits, and plan choices will remain relatively stable in 2024.  “A top priority for CMS...

How Do Rebates Impact Part D Spending for Plans, Beneficiaries?

by Victoria Bailey

While rebates may lower Medicare Part D spending for plan sponsors, they do not reduce drug costs for Medicare beneficiaries, a study conducted by the US Government Accountability Office (GAO)...

Medicare Part D Patients with HIV May See Lower Drug Costs Under IRA

by Kelsey Waddill

The Inflation Reduction Act’s Medicare Part D redesign may improve affordability for beneficiaries with HIV, but stakeholders will need to take steps to ensure beneficiaries get the most out of...

CMS Announces Monthly Payment Option for Out-of-Pocket Part D Costs

by Victoria Bailey

CMS has released draft guidance detailing a new program allowing Medicare beneficiaries to pay out-of-pocket Part D costs in monthly installments. The Medicare Prescription Payment Plan is required...

CMS Projects 2024 Medicare Part D Premiums Will Fall by 1.8%

by Victoria Bailey

Medicare Part D premiums are projected to decrease from $56.49 in 2023 to $55.50 in 2024, CMS announced. The projected average Part D premium represents the sum of the average basic premium and the...

Humira Price for Commercial Plans Remained Steep Despite High Rebates

by Victoria Bailey

Despite increasing rebates, the net price of Humira for Medicaid and commercial health plans in 2020 remained high above the launch price, according to a study published in JAMA Network Open. The...

10 Top-Selling Drugs Accounted for 22% of Medicare Part D Spending

by Victoria Bailey

The ten top-selling prescription drugs accounted for more than 20 percent of total gross Medicare Part D spending in 2021, a KFF analysis revealed. Under the Inflation Reduction Act’s Medicare...

Medicare Advantage, Part D Premiums Increased Slightly in 2023

by Victoria Bailey

Average monthly premiums for Medicare Advantage and Part D plans have increased in 2023, and fewer beneficiaries selected zero-dollar premium plans, a report from eHealth, Inc. found. eHealth’s...

Adjusting Medicare Drug Price Negotiation Criteria May Increase Savings

by Victoria Bailey

Adjusting eligibility criteria for Medicare prescription drug price negotiation under the Inflation Reduction Act to include drugs with biosimilars and allow for drug selection based on net spending...

How the Inflation Reduction Act Impacted Medicare Part D Benefit Design

by Kelsey Waddill

Medicare Part D plan liability could lead to major changes in benefits and formulary design for beneficiaries in the coming years, according to an Avalere study that was funded by PhRMA. The...

HHS Introduces Models for Lowering Prescription Drug Spending

by Kelsey Waddill

The Department of Health and Human Services (HHS) has released three models intended to bring down prescription drug spending for consumers in Medicare and Medicaid. “These selected models will...

Overview of the 2024 Medicare Advantage Advance Notice, Payer Reactions

by Kelsey Waddill

CMS released the 2024 Medicare Advantage Advance Notice with changes for Medicare Advantage plans and Medicare Part D, stirring up concerns among some large payer organizations. “Medicare...

Medicare Advantage Premiums Rise, Zero-Dollar Premium Plan Uptake Declines

by Kelsey Waddill

Medicare Advantage premiums rose to $7 per month on average for 2023 open enrollment season, an eHealth survey uncovered. For the past four years, Medicare Advantage plan premium costs have been...

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