Consumer Engagement

After nearly four years, CMS has released an updated version of the Medicare Communications and Marketing Guidelines (MCMG) that serve to interpret and provide guidance on the marketing and communication rules for Medicare Advantage and Part D sponsors. Compliance experts tell AIS Health, a division of MMIT, that the long-awaited document is light on additional guidance and clarification except for a few topics, and plans are encouraged to review all related regulations to stay compliant with marketing rules.

Aside from severely whittling down the document — the 2022 MCMG is now a mere 51 pages, down from 84 pages when last released as a full document for the 2019 plan year and 124 pages in the 2018 version — CMS has noticeably consolidated and reorganized sections, moving some subsections into other areas or removing guidance that was codified. The agency reminded plans that the document is to “be used in conjunction with the regulatory requirements to aid plans in understanding and complying with the regulations.”

To prevent deaths and injuries related to prescription opioid misuse, research has shown that coprescribing the overdose-treatment drug naloxone when patients on chronic pain-management therapy receive high doses of opioids can make a big difference. Yet federal data show that less than 1% of patients who should be prescribed naloxone with their opioid medications obtain a prescription for it — a rate that managed care entities can play a role in changing, according to a new paper from the Academy of Managed Care Pharmacy (AMCP) Addiction Advisory Group.

The AMCP Addiction Advisory Group in 2019 polled AMCP payer members, addiction treatment providers and managed behavioral health organizations, with the goal of understanding and evaluating “trends in treatment, coverage, policies, and needs associated with providing health services to patients with substance use disorders.” One particularly notable finding was that 80% of the managed behavioral health organizations and 47% of AMCP payer members who responded to the survey encouraged naloxone coprescribing in patients at high risk of overdose, but “no organizations required coprescribing.”

Under the Biden administration, federal drug regulators have homed in on misleading or imbalanced claims on social media, and early evidence shows those efforts will be a key focus in 2022. According to legal experts, pharmaceutical companies and medical device manufacturers that turn to influencers, celebrities and popular social media channels to promote their products should heed compliance warnings.

The FDA, through its Office of Prescription Drug Promotion (OPDP), issued six enforcement letters — two warning letters and four untitled letters — to pharmaceutical companies in 2021. While drugmakers continue to operate in an era of relatively low-volume enforcement (the FDA also issued six enforcement letters in 2020, down from more than 50 warnings a decade before) the areas of focus are evolving, according to a Jan. 25 webinar hosted by law firm King & Spalding LLP.

For our annual series of forward-looking articles, AIS Health recently featured the perspectives of multiple industry experts on what Medicare Advantage stakeholders will be focusing on in 2022. For a follow-up installment, we asked several health plan leaders to share how their respective organizations will be innovating this year to meet aging members’ needs, advance health equity and address social determinants of health (SDOH) amid the backdrop of the ongoing COVID-19 pandemic.

“The pandemic emphasized how our most daunting challenge — reaching our members in a new remote, digital-first landscape — remains our most compelling opportunity. Delivering home-based care to our nearly 10 million Medicare members and equipping them with the resources they need to age in place are central to our 2022 agenda,” says Jamie Sharp, M.D., vice president and chief medical officer of Aetna Medicare, a CVS Health company.

New drugs are becoming less expensive to bring to market and more profitable at launch, according to a new Deloitte Ltd. white paper. “Cost to bring an asset to market has declined over the past three years, as peak sales forecasts increase,” the report says. “The combined cohort’s average cost to develop an asset was $2,006 million, a decrease of $370 million from 2020....This decrease in 2021 compared to 2020 is due mainly to the overall increase in the number of assets in the late-stage pipeline.” However, the report also notes that this figure is “an increase of $710 million from 2013.” In addition, the cycle time for drug development has increased, especially since the start of the pandemic.

New Hampshire is the latest state to settle its suit against Centene Corp, accepting $21 million from the Medicaid-focused carrier. More than a dozen states have sued the health insurer, accusing Centene of mismanaging their Medicaid programs’ pharmacy benefits. As with the other settlements, in the New Hampshire agreement Centene denied it was liable for any wrongdoing or violations of federal or state statute. The insurer has paid out more than $241 million in settlements with Arkansas, Illinois, Kansas, Mississippi and Ohio out of the $1.25 billion it set aside earlier this year to settle such suits.

With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be a landmark year in terms of changes to Medicare Advantage organizations’ star ratings strategies, industry experts tell AIS Health, a division of MMIT.

“There is so much earth-shattering change on the horizon that most plans are just not thinking about,” cautions Melissa Newton Smith, executive vice president, consulting and professional services with Healthmine, Inc. “We’re worried that COVID took up way too much airtime and that plans have lost sight of the forest through the trees in MA a little bit.”

As the use of real-world data in the health care system grows, a recent HHS rule giving patients electronic access to their data stands to have a huge impact on this area. And the trend doesn’t show any signs of slowing, with companies such as Amazon.com Inc., Apple Inc., Google and Microsoft Corp. exploring opportunities in the health care industry though the use of patients’ medical data. Various stakeholders within the health care industry stand to benefit from this access in a variety of ways.

The Office of the National Coordinator for Health Information Technology (ONC) last year issued a final rule — The 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program — in order to implement some electronic health information (EHI) and interoperability provisions of the 21st Century Cures Act.