Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

CMS Releases Proposed Changes to Medicare Advantage and Part D for 2017

March 3, 2016

Medicare Rights to Comment on 2017 Advance Rate Notice and Call Letter

Last week, the Centers for Medicare & Medicaid Services (CMS) released its 2017 Advance Rate Notice and draft Call Letter (2017 Advance Notice and Call Letter) for the Medicare Advantage (MA) and Part D programs. Medicare Rights is preparing comments which will be submitted on March 4, 2016.

The 2017 Advance Notice and Call Letter proposes a variety of updates, including changes to payment methodologies that are designed to improve the accuracy of payments to plans serving beneficiaries dually eligible for Medicare and Medicaid. CMS also proposes changes to the way employer sponsored Medicare Advantage plans are paid–reducing administrative burdens on those plans and also reducing historic overpayments. In addition, CMS reports on a pilot program to help beneficiaries secure prescription drug coverage when turned away at the pharmacy counter and solicits comments on potential policy changes based on the pilot findings.

Medicare Rights’ comments will be supportive of some of the proposed changes, including the improved payment strategy for plans serving low income individuals. The comments will also commend CMS’ pilot program on pharmacy counter refusals, while also expressing disappointment that the improvements to the Part D appeals process promised in the last year’s call letter have not been implemented.

Read the full 2017 Advance Rate Notice and draft Call Letter.

Kaiser Family Foundation Releases Brief on Government Negotiation of Prescription Drug Prices

According to polling by the Kaiser Family Foundation (KFF), most Americans (83%) support allowing the federal government to negotiate the price of prescription drugs in the Medicare program in order to control costs. This includes a majority of Democrats (93%) and Republicans (74%).

Prescription drug prices in Medicare have recently started to rise partly due to spending on blockbuster drugs, like life-saving treatments for Hepatitis C. Medicare accounts for a significant portion of national prescription drugs spending (29% in 2014), and costs in the Part D program are expected to increase annually by 6.5% over the next 10 years.

Some policymakers propose giving the Secretary of the Department of Health and Human Services (HHS) the authority to negotiate prescription drug prices, leveraging the millions of people with Medicare to lower the prices of prescriptions, particularly medications with high prices and no competitive alternatives. Opponents of this proposal claim that the HHS Secretary will not be able to secure lower drug prices than the private Medicare plans that already negotiate the price of medications. Some also argue that if HHS were to secure lower prices, pharmaceutical companies would decrease spending on research and development of new prescription drugs in order to compensate for the lower prices.

Medicare Rights supports allowing the Medicare program to negotiate Part D prescription drug prices just like state Medicaid programs and the Veteran’s Administration do for their populations. We also support granting the HHS Secretary additional tools to use in those negotiations, such through the creation of a public Part D benefit administered by the Medicare program.

Read the KFF brief.

Volume 7, Issue 7

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Medicare Reminder

If you were denied coverage for a prescription drug, you should ask your plan to reconsider its decision by filing an appeal. Your appeal process will be the same whether you have a stand-alone Part D prescription drug plan or a Medicare Advantage plan that includes your Part D prescription drug coverage.

If your pharmacist tells you that your plan will not pay for your prescription drug, you should call your plan to find out the reason it is not covering your drug. Then, you should talk to your prescribing physician about your options. If switching to another drug is not an option, you should file an exception request – a formal coverage request – with your plan. Call your plan to learn how to file an exception request. Make sure you get a letter of support from your doctor and include that with your request.

Your plan should issue a decision within 72 hours. File an expedited request if you need your drug right away, and your plan should issue a decision within 24 hours. If your request is approved, your drug will be covered. If it is denied, you should follow the directions on the written denial you receive to appeal.

Learn more about this process on Medicare Interactive.

Access an interactive roadmap for this process on Medicare Interactive.



This week, Paula Arboleda, senior legal advocate at the New York Legal Assistance Group (NYLAG), published a blog post on the Huffington Post applauding the continued funding of the Managed Care Consumer Assistance Program (MCCAP) in New York Governor Andrew Cuomo’s latest executive budget.

MCCAP is a crucial program comprised of a network of New York organizations, including Medicare Rights, that works to assists older adults and people with disabilities by helping them access needed health services and afford the cost of their Medicare. People with Medicare and/or Medicaid, their caregivers and family members, as well as the professional who serve them can get help from the MCCAP program through hands-on assistance, consumer hotlines, live and web-based training programs, and educational workshops.

Read more about the MCCAP program on the Huffington Post.


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