CMS recently released its annual payment information and policy updates for Medicare Advantage, MA Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans, underscoring the need for a better approach to opioid monitoring and management, AIS Health reported.
Yet overall, industry experts say perhaps the most eye-catching features of CMS’s 2020 MA and Part D Rate Announcement and final Call Letter are the better-than-anticipated pay rate and the lack of worrisome new mandates, policy changes or major technical issues.
By incorporating an underlying “coding trend,” which CMS says will boost risk scores by 3.3%, on average, MA plans likely will see somewhere in the neighborhood of a 5.5% rate hike on average year over year, says Tim Courtney, director and senior consulting actuary of Wakely Consulting LLC.
“There just weren’t a lot of notable, earth-shaking changes this year [for the Part D program], which is good,” says Wayne Miller, R.Ph., vice president of pharmacy solutions for Gorman Health Group LLC.
“I think there’s more change coming in the [Medicare quality] star ratings measures being implemented around the opioids,” he adds, pointing to CMS’s addition of a 2020 display measure on how plans manage members’ use of opioids at higher dosages.
The agency in its 2020 final Call Letter urges Medicare plans to take voluntary steps to improve drug utilization review controls for opioids. It also says that it is “encouraging” Part D plan sponsors “to include at least one naloxone product on a generic or Select Care Tier.”