This post was co-written by Joseph Burns (@jburns18), a Massachusetts-based independent journalist and AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at email@example.com.
You may have seen the April 2 press release from the Centers for Medicare and Medicaid Services that highlighted the steps it is taking to, among other efforts, advance a more patient-centered approach, reinterpret standards for supplemental benefits under Medicare Advantage plans, lower prescription drug prices and address the opioid crisis. While that’s a lot to promise in a page and a half, more details are available in CMS’ 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. Be forewarned, however, that many journalists may need experts to interpret the implications of what CMS calls its call letter. Continue reading
A report released Friday by the Office of the Inspector General found that, under the Part D program, Medicare paid for HIV drugs for 150 dead recipients.
An analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012 determined that CMS’s current practices allowed most of these payments to occur. Although CMS has processes in place that reject PDE records for drugs with dates of service more than 32 days after death, in some cases, claims that fell outside this window were paid. Most of these drugs were dispensed by retail pharmacies.
According to OIG, “Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive.” The report points out, for example, that one common antiretroviral drug costs approximately $1,700 per month. HIV drugs accounted for one-quarter of one percent of all Part D drugs in 2012.
Image by Amanda M Hatfield via flickr.
Perhaps the federal Centers for Medicare & Medicaid Services (CMS) learned a lesson over the past few weeks when it tried to make changes in its Part D prescription drug program. The lesson: Don’t mess with Part D in an election year.
On Monday, CMS withdrew its proposal to revise the Part D program, a proposal that drew widespread criticism from congressional Republicans and Democrats and from groups of patients, among others. Those in opposition said the proposal would undermine Part D, which members of Congress called a successful and popular program. More than 36 million elderly and disabled Americans get prescription drug coverage through Part D.
“Late last week, more than 370 organizations representing insurers, drug makers, pharmacies, health providers and patients urged CMS to withdraw changes it had proposed for Medicare Part D,” wrote David Morgan of Reuters. “The Republican Party had already begun to look for ways to leverage popular anger over the changes into campaign attacks on Democratic incumbents who could be vulnerable in November’s election showdown for control of Congress.” Continue reading