This week, the Centers for Medicare and Medicaid Services (CMS) announced that, starting in 2020, Part D Plans and Medicare Advantage Plans with Part D will be able to include medications on their formulary for some FDA-approved uses, but not others. Currently, a plan can favor one drug over another by: including a medication on its formulary or not; placing it on a lower cost sharing tier; or putting coverage restrictions, like prior authorization, quantity limits, or step therapy on the less preferred medication. These rules apply uniformly to each drug, for all FDA- and compendia-approved purposes—the new rules do not.

This week, the Centers for Medicare & Medicaid Services (CMS) announced that next year, Medicare Advantage (MA) Plans will be able to limit options for people who get Part B-covered drugs by using many of the same tools plans currently use in Part D. The Trump administration argues that this will enable plans to negotiate better prices for the “preferred” medications – those that the plan will cover as a first-line treatment. Other drugs will only be covered if a person tries the preferred medication first and it doesn’t work or causes them harm, also known as step therapy.

After a Federal Judge invalidated the previously approved plan by the Centers for Medicare & Medicaid (CMS) to require very low income parents and caregivers to show that they are working or engaged in other activities in order to qualify for Medicaid coverage in Kentucky, CMS re-released the rule and another one governing Mississippi for additional comments.

This week, the Kaiser Family Foundation (KFF) released an issue brief analyzing the availability of, and enrollment in Medigaps across different states. One in four people in traditional Medicare had this private, supplemental health insurance in 2015. Medigaps help cover Medicare deductibles and cost-sharing, reduce the out-of-pocket burden associated with accessing care, and protect against high costs because of catastrophic illness or injury.

This week, the Kaiser Family Foundation released a new issue brief on Medicare spending. The brief analyzes the most recent historical and projected Medicare spending data published in the 2018 annual report of the Boards of Medicare Trustees and the 2018 Medicare baseline and projections from the Congressional Budget Office (CBO).

In 2017, Medicare spending accounted for 15% of the federal budget, and for 20% of total national health spending in 2016. It also accounted for 29% of spending on retail sales of prescription drugs, 25% of spending on hospital care, and 23% of spending on physician services.

In its annual report to Congress, the Board of Trustees for Medicare said the program’s hospital insurance trust fund (Part A) could lack funds to pay full benefits by 2026—three years earlier than projected in last year’s report. Despite this finding, the Medicare program itself remains strong and sustainable. The trustees report identifies several factors that impact the balance of program funds.

The Kaiser Family Foundation released a new report looking at the history of the concept of Medicare drug price negotiation, including the dramatically different role that the federal government has in securing good prices for Medicare beneficiaries, compared to its active involvement in establishing drug prices for other government health programs, including Medicaid and the Department of Veterans Affairs (VA). The report outlines various bills that have been introduced in Congress since the enactment of the Part D benefit, and discusses how enthusiasm for making this change tracks closely with the rate of increase in Part D drug costs.

The recently-passed Bipartisan Budget Act of 2018 (BBA of 2018) makes a number of changes to Medicare, including permanently authorizing Dual Special Needs plans (D-SNPs), which are Medicare Advantage (MA) plans for people who are dually eligible for Medicare and Medicaid.

To help inform implementation of these changes, earlier this month the Centers for Medicare & Medicaid Services (CMS) issued a request for stakeholder input on (1) The design of an integrated Medicare-Medicaid appeals approach for D-SNPs; and (2) The establishment of minimum state contract requirements for D-SNPs.

This week, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Advantage and Part D 2019 Rate Announcement and Call Letter. This is the finalized annual update to Medicare Advantage and Part D programs, which includes payment updates and policy changes for payment in calendar year (CY) 2019.

The Commonwealth Fund recently released a report analyzing different proposals by states to impose a work requirement for Medicaid benefits and how those proposals would impact older adults and people with disabilities. To date, 12 states have proposed conducting demonstrations that add work requirements to Medicaid, and the Centers for Medicare & Medicaid Services (CMS) has so far approved proposals from Kentucky, Indiana, and Arkansas. Among other policy changes, these demonstrations would tie Medicaid benefits to a minimum work requirement.