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New Medicare Part D and Advantage Models Could be Game Changers

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    I came a cross an article from the first of the year that I thought would be interesting. The Center for Medicare and Medicare Services (CMS) launched two new models in January. One is a new payment model and the other has updated an existing model which is aimed at lowering drug prices, and better serving patients of Medicare Part D and Medicare Advantage plans.

    “Expanding choices for patients, aligning incentives, and providing new flexibility for insurers in Medicare Advantage and Medicare Part D will deliver better value from these programs,” said HHS Secretary Alex Azar.

    The new Part D plan, called the Part D Payment Modernization Model, aims at creating incentives to lower drug prices, as well as out-of-pocket costs.

    Another interesting point from the article:

    Currently in Part D, when a patient’s prescription drug spending is high enough for the patient to enter the highest phase of the benefit, known as the “catastrophic phase,” Medicare is responsible for 80 percent of the drug costs.

    With this rule in place, plans have little reason to negotiate lower costs for the highest-spending patients.

    The new model would make it to where participating Part D plans would share in the savings if they stay below the target, but would be responsible for losses if they did. It would also provide tools to Part D plans to control drug costs and help enrollees choose more affordable drugs.

    The update to the Medicare Advantage Value-Based Insurance Design model will allow plans to provide reduced cost sharing and other benefits to enrollees, in a much more targeted way.

    The new model allows plans to boost the rewards and incentives programs that can help beneficiaries improve their health and increases access to telehealth services by allowing plans to use virtual services instead of in-person visits.

    I think this is good news across both forms of Medicare. The main complaint about Medicare Advantage has been drug costs and limited networks. Think these new models could be better? What else should be implemented and reworked?

  • Are you sure you want to delete this post?
    Interesting. Not sure on your question. Was going to throw it back to you actually.. which do you think got the better updates in your estimation? Did one improve to make it the better option, traditional + D vs Advantage? I know there are pros and cons to both..