Medicare Advantage and Part D

From Medicare Advantage News - Both CMS and Aetna Inc. learned valuable lessons as a result of what the company now acknowledges were its confusing efforts to institute multiple pharmacy networks in Medicare Part D plans this year, the two organizations said at a conference last month. Speaking at the agency’s fall Medicare Advantage and Part D conference in Baltimore Sept. 10, Aetna executives outlined what they did to rectify the well-publicized problems, which led to CMS assessing a $1 million fine against Aetna (MAN 4/23/15, p. 4). Read more

From Medicare Advantage News - The switch by NCQA from a ranking to a rating methodology in its health plan evaluations did not seem to have a major impact on which plans were identified as the top Medicare performers in its annual list. The new stars-like ratings that the accreditation group released Sept. 17 include among the nine plans that won its top rating of 5.0 (see table, below) eight that were in the top… Read more

Medicare Advantage & Part D Blog

By James Gutman - November 18, 2015
If there were any doubts that CMS is committed to furnishing meaningful financial relief to Medicare plans serving highly disadvantaged populations, two memos it issued within the last week should dispel them. In both cases, however, the exact way in which the agency will furnish the relief is...
By James Gutman - November 10, 2015
Medicare Advantage plan sponsors and pharmaceutical producers always have had somewhat of an uneasy relationship since what is revenue to the drugmakers is cost to the insurers, at least in the short run. But the two sectors were able to put aside their differences when the Affordable Care Act (ACA...
By James Gutman - October 29, 2015
In the course of less than a day and a half Oct. 19 and 20, CMS seemingly changed the entire mindset of many Medicare insurers serving highly disadvantaged populations from despair to cautious optimism. Its two top officials did that in separate presentations at a major industry conference that put...

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