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Medicare Watch

Medicare Watch articles are featured in a weekly newsletter that helps readers stay up-to-date on Medicare policy and advocacy developments, and learn about changes in Medicare benefits and rules.

Surprise Administrative Decision Puts Millions at Risk of Losing Health Coverage

Last week, the Department of Justice (DOJ) asked a federal court in Texas to end the Affordable Care Act’s (ACA) protections for people with pre-existing conditions. The underlying legal challenge was filed earlier this year by 20 state attorneys general, who argue that without the individual mandate—which was eliminated in December’s Tax Cuts and Jobs Act—the entire is ACA unconstitutional. In an unexpected move, the DOJ declined to defend the ACA in this case, and instead asked the court to invalidate only the law’s provisions that prevent insurers from denying coverage or charging higher rates based on health status.

Read More »

Medicare Rights Opposes Potential New Medicare Model that Puts Beneficiaries at Risk

Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals.

In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for. While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which leaves some dangerous options on the table.

Read More »

Shifting Drugs from Part B to Part D May Create Winners and Losers

This week, Avalere Health, a Washington DC-based consulting firm that specializes in strategy, policy, and data analysis, released a study on the impact of moving the coverage of some drugs from Medicare Part B to Part D. While most drugs are covered under the Part D prescription drug program, Part B, the part of the Medicare program that covers outpatient medical services like office visits, covers a few. The drugs covered by Part B are usually ones that beneficiaries would not give to themselves. For example, if a provider administers the drug during an office visit, Part B instead of Part D, might cover that drug.

Earlier this month, the Trump Administration announced it would consider transitioning certain Part B drugs into Part D as part of a larger strategy to lower drug prices and out-of-pocket costs. This makes it essential to understand what effects the switch could have on people with Medicare.

Read More »

Beneficiary Advocates Urge Centers for Medicare & Medicaid Services to Correct Inaccuracies in Medicare & You Handbook for 2019

This week, the Medicare Rights Center, the Center for Medicare Advocacy, and Justice in Aging sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), on May 15, 2018, objecting to serious inaccuracies in the draft Medicare & You Handbook for 2019, and urging CMS to rectify the errors prior to disseminating the Medicare & You Handbook.

Read More »

New Drug Spending Tool May be Helpful for Researchers and Policymakers—Not Much Help for Consumers

This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboard allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard.

Read More »
a roll of bills from which spill out pills of many colors

Trump Administration Unveils Drug Pricing Strategy

On Friday, President Trump and U.S. Department of Health and Human Services (HHS) Secretary Azar outlined the Administration’s strategy to reduce drug prices. The Administration further described the plan, “American Patients First,” in a blueprint document also unveiled Friday.

The much-anticipated plan is a mix of existing policies laid out in the Administration’s 2019 budget request, as well as some new ideas designed to drive down drug prices and lower costs. Though neither the speech nor the blueprint offers much detail about the Administration’s next steps, there are several aspects of the plan that could significantly impact people with Medicare. This includes potential changes to how certain drugs are covered by Medicare, as well as proposals to reconsider the obligations of Pharmacy Benefit Managers (PBMs), and arrangements between Part D plans and drug manufacturers.

Read More »

Hearing on the Medicare Advantage Program Highlights Need for Improved Beneficiary Outreach and Education

This week, the U.S House of Representatives Committee on Ways and Means Health Subcommittee held a hearing on the Medicare Advantage (MA) program. MA allows people with Medicare to choose a private insurance option instead of traditional Medicare. Witnesses included representatives from two MA plans—Andrew Toy of Clover Health and Daphne Klauser of Independence Blue Cross—who spoke to their experience administering MA plans, as well as Dr. Karoline Mortensen, Associate Professor of the Department of Health Sector Management and Policy at the University of Miami Business School, who discussed quality measures in MA plans. Dr. Jack Hoadley, Research Professor Emeritus at Georgetown University’s McCourt School of Public Policy and former Commissioner on the Medicare Payment Advisory Commission (MedPAC) also testified, speaking for himself and not on behalf of Georgetown or MedPAC.

Read More »

Health Care Legislation Cropping Up in Unexpected Places

This week, several health care programs appeared in legislation that does not normally address health care. Two of the surprise provisions are embedded in draft Farm Bill legislation and in cuts, or rescissions, requested by the White House. While these measures may gain traction in the U.S. House of Representatives, they face a more uncertain future in the Senate.

Read More »

Surprise Administrative Decision Puts Millions at Risk of Losing Health Coverage

Last week, the Department of Justice (DOJ) asked a federal court in Texas to end the Affordable Care Act’s (ACA) protections for people with pre-existing conditions. The underlying legal challenge was filed earlier this year by 20 state attorneys general, who argue that without the individual mandate—which was eliminated in December’s Tax Cuts and Jobs Act—the entire is ACA unconstitutional. In an unexpected move, the DOJ declined to defend the ACA in this case, and instead asked the court to invalidate only the law’s provisions that prevent insurers from denying coverage or charging higher rates based on health status.

Medicare Rights Opposes Potential New Medicare Model that Puts Beneficiaries at Risk

Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals.

In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for. While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which leaves some dangerous options on the table.

Shifting Drugs from Part B to Part D May Create Winners and Losers

This week, Avalere Health, a Washington DC-based consulting firm that specializes in strategy, policy, and data analysis, released a study on the impact of moving the coverage of some drugs from Medicare Part B to Part D. While most drugs are covered under the Part D prescription drug program, Part B, the part of the Medicare program that covers outpatient medical services like office visits, covers a few. The drugs covered by Part B are usually ones that beneficiaries would not give to themselves. For example, if a provider administers the drug during an office visit, Part B instead of Part D, might cover that drug.

Earlier this month, the Trump Administration announced it would consider transitioning certain Part B drugs into Part D as part of a larger strategy to lower drug prices and out-of-pocket costs. This makes it essential to understand what effects the switch could have on people with Medicare.

Beneficiary Advocates Urge Centers for Medicare & Medicaid Services to Correct Inaccuracies in Medicare & You Handbook for 2019

This week, the Medicare Rights Center, the Center for Medicare Advocacy, and Justice in Aging sent a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), on May 15, 2018, objecting to serious inaccuracies in the draft Medicare & You Handbook for 2019, and urging CMS to rectify the errors prior to disseminating the Medicare & You Handbook.

New Drug Spending Tool May be Helpful for Researchers and Policymakers—Not Much Help for Consumers

This week, the Centers for Medicare & Medicaid Services (CMS) released new data and a new tool on prescription medication: the Drug Spending Dashboard. The Dashboard allows users to see list prices of various medications, how many manufacturers supply the drug, what they have been paid by Medicare—both Part B and Part D—and Medicaid, total and per beneficiary spending on the drug, and comparisons of spending from 2015 to 2016. Such data show trends in both drug pricing and program spending, and CMS offers additional data for use outside of the Dashboard.

a roll of bills from which spill out pills of many colors

Trump Administration Unveils Drug Pricing Strategy

On Friday, President Trump and U.S. Department of Health and Human Services (HHS) Secretary Azar outlined the Administration’s strategy to reduce drug prices. The Administration further described the plan, “American Patients First,” in a blueprint document also unveiled Friday.

The much-anticipated plan is a mix of existing policies laid out in the Administration’s 2019 budget request, as well as some new ideas designed to drive down drug prices and lower costs. Though neither the speech nor the blueprint offers much detail about the Administration’s next steps, there are several aspects of the plan that could significantly impact people with Medicare. This includes potential changes to how certain drugs are covered by Medicare, as well as proposals to reconsider the obligations of Pharmacy Benefit Managers (PBMs), and arrangements between Part D plans and drug manufacturers.

Hearing on the Medicare Advantage Program Highlights Need for Improved Beneficiary Outreach and Education

This week, the U.S House of Representatives Committee on Ways and Means Health Subcommittee held a hearing on the Medicare Advantage (MA) program. MA allows people with Medicare to choose a private insurance option instead of traditional Medicare. Witnesses included representatives from two MA plans—Andrew Toy of Clover Health and Daphne Klauser of Independence Blue Cross—who spoke to their experience administering MA plans, as well as Dr. Karoline Mortensen, Associate Professor of the Department of Health Sector Management and Policy at the University of Miami Business School, who discussed quality measures in MA plans. Dr. Jack Hoadley, Research Professor Emeritus at Georgetown University’s McCourt School of Public Policy and former Commissioner on the Medicare Payment Advisory Commission (MedPAC) also testified, speaking for himself and not on behalf of Georgetown or MedPAC.

Health Care Legislation Cropping Up in Unexpected Places

This week, several health care programs appeared in legislation that does not normally address health care. Two of the surprise provisions are embedded in draft Farm Bill legislation and in cuts, or rescissions, requested by the White House. While these measures may gain traction in the U.S. House of Representatives, they face a more uncertain future in the Senate.