Medicare Part D Archives - Applied Policy

CMS Finalizes Policies for Medicare Advantage and Part D Plans in 2022, Allows Second Specialty Tier, Releases 2022 Benefit Parameters

On January 15, 2021, the Centers for Medicare & Medicaid Services (CMS) released a final rule containing policies for Medicare Advantage (MA) and Medicare Part D plans in contract year 2022. The rule finalizes policies initially proposed in February 2020. Some policies in that February proposed rule were finalized in previous rulemaking while the remainder [...] Read More

Trump Administration Finalizes Rule to Prevent PBM Rebates Almost Two Years After Initial Proposal

On November 20, 2020, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a final rule that removes the existing legal safe harbor that protects rebates currently negotiated between pharmaceutical manufacturers and Medicare Part D prescription drug plans, either directly or through Pharmacy Benefit Managers (PBMs). To replace this rescinded [...] Read More

CMS Finalizes Policies for 2021 MA and Part D Plans; Pushes Certain Proposals, Including Second Specialty Tier, to Subsequent Final Rule

On May 22, 2020, the Centers for Medicare & Medicaid Services (CMS) released a final rule adopting policies for contract year 2021 for Medicare Advantage (MA) and Medicare Part D. Acknowledging the upcoming MA and Part D bid deadlines for the 2021 plan year, CMS has decided only to address a portion of the proposed [...] Read More

CMS Proposes Adding Second Specialty Tier Option to Part D, Additional Opioid Drug Management Programs; Call Letter Includes Technical Updates

CMS has released a proposed rule that would update program policies for Medicare Advantage and Medicare Part D beginning in 2021, if finalized. CMS has also released the draft Call Letter for 2021; however, this year’s Call Letter is limited to standard benefit parameters, risk-sharing, and other technical details and does not feature any additional [...] Read More

MedPAC Continues Work on Part D, Unified Payment System for Post-Acute Care

On October 3-4, 2019, the Medicare Payment and Access Commission (MedPAC) held their second public meeting of the current term. Topics discussed include restructuring the Medicare Part D benefit, population-based outcome measures, and the methods used to assess the adequacy of Medicare payments. MedPAC Explores Restructuring the Part D Benefit The meeting began with the [...] Read More

In Additional Guidance to Part D Plan Sponsors, CMS Confirms Rebate Proposal Will Not Be Finalized Before 2020 Bid Submission

Earlier this week, the Centers for Medicare and Medicaid Services (CMS) released a memo to Part D plan sponsors with some additional information about submission of calendar year (CY) 2020 Part D plan bids. The bid submission deadline is June 3, 2019 and many stakeholders had been asking whether the recent rebate proposal would be [...] Read More

CMS Finalizes Administrative Updates to MA & Part D, Expands Access to Telehealth Benefits, Refines Prescriber Preclusion List

On April 5, 2019, the Centers for Medicare and Medicaid Services released a final rule of administrative and technical changes to Medicare Advantage and Medicare Part D. Many of the changes in this rule were mandated by the Bipartisan Budget Act of 2018 (BBA). Most of the provisions in this final rule will go into [...] Read More

CMS Lets Plans off With a Warning Regarding Generics, But Increased Out-of-Pocket Threshold for 2020 Looms Large

On April 1, 2019, CMS released the final Medicare Advantage and Part D Call Letter for the 2020 plan year. While the Call Letter itself was relatively quiet, compared to other Administration activities around the two benefits, CMS pulled back on a proposal to limit plan sponsors from placing generic drugs on tiers labeled “brand” [...] Read More

Proposals for 2020 Medicare Advantage and Part D Plans Released, Opioids and Generic Access Continue to be a Focus

The Center for Medicare and Medicaid Services (CMS) has released the plan year 2020 Draft Call Letter outlining proposed changes to policies impacting Medicare Advantage (MA) and Part D prescription drug plans (PDPs). The agency is continuing to focus on changes that will modernize the MA and PDP benefits to make the plans operate closer [...] Read More

New Innovation Model for Part D Announced, Medicare Advantage VBID Model to Expand

On Friday, January 18, the Centers for Medicare and Medicaid Services (CMS) announced two new model programs that will be available to Medicare Part D and Medicare Advantage plans in 2020: Part D Modernization Model. The model, which would run for five years, and would be voluntary, would require plan sponsors to take on additional [...] Read More

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Archive Tag: Medicare Part D