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February 15, 2018

Recent Stories

From Medicare Advantage News - CMS last month posted the results of its second year reviewing the online provider directories of Medicare Advantage organizations, and plan sponsors appear to be no better than they were last year at updating the listings, despite CMS’s efforts to strengthen existing sub-regulatory guidance and share best practices from its initial review of directories. Read more

As more consumers “age-in” to the Medicare program and waffle on whether… Read more

CMS made mainstream news this month when it issued its first-ever guidance… Read more

In a new memo posted this month, CMS confirmed plans to remove… Read more

From the Editor

Welcome to Your Radar on Medicare Advantage Subscriber Website

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

Exclusively for subscribers to Radar on Medicare Advantage (formerly Medicare Advantage News), this website is your source for PDFs of back issues, archives of articles and data, and more!

Please e-mail me with your comments on the last issue of Radar on Medicare Advantage, story ideas for future issues, or any other suggestions you have that can make the newsletter more useful for you.

January 25, 2018
Latest Round of MAO Provider Directory Reviews Turned Up 'Significant Errors'

The second round of reviews from CMS's online provider directory accuracy project are in, and it appears that despite CMS’s efforts to strengthen existing sub-regulatory guidance and share best practices from its initial review of directories, Medicare Advantage provider listings are rife with errors. Findings from the Jan. 19 "Online Provider Directory Review Report" include that plans are continuing to post listings with the same frequently identified inaccuracies and that the average MA organization inaccuracy rate by location was 48.39%, compared with 41.37% identified in last year’s report.
View all the findings in the report.

January 18, 2018
Azar Intends to Preserve MA as "Robust Alternative" to FFS Medicare

The Senate Finance Committee on Jan. 17 voted 15-12 to approve Alex Azar II as the next HHS secretary, sending his nomination to the Senate floor. During a Jan. 9 hearing to evaluate Azar, many Senate Finance Committee members pressed him about his ties to the pharmaceutical industry and the price increases of certain drugs made by Eli Lilly & Co. during his tenure as CEO of the company’s U.S. division. Azar repeatedly responded that he believes the cost of all prescription drugs in the U.S. is too high and identified drug costs as one of four “critical areas” he would focus on if confirmed, the others being insurance market affordability and price, the shift from volume-based to value-based health care and the opioid epidemic.

But Azar, who served as general counsel and deputy secretary of HHS under President George W. Bush, was also queried about his stance on Medicare, Medicaid and various aspects of those programs that he would oversee as secretary. Here are highlights from Azar’s responses that may provide further clarity for insurers and pharmacy benefit managers as they contemplate the future of government-sponsored health care under Azar:

  • On possible changes to Medicare: “I am not aware of any proposals by the administration to turn the program into a voucher program. What I want to do is really make sure that our Medicare Advantage program, which two-thirds of new enrollees are signing up for — and I played a role in helping to launch and think is a great option for our seniors as they come into [the] program — I really want to make sure we’re doing everything that we can to make sure it’s a strong, robust alternative for our seniors. That’s where my energies are; my focus is there.”
  • On the role of government in negotiating drug prices: “I think where the government doesn’t have negotiation it’s worth looking at....In Part D, we do significant negotiation through pharmacy benefit managers that get the best rates of any commercial payers. We don’t do that in Part B....Where we can do so that preserves innovation and preserves access for patients, I want to look at anything that’s going to help us with drug pricing and in Part B I think we should be looking at those approaches....For the government to negotiate [in Part D], we would have to have a single, national formulary that restricted access to all seniors for medicines....I don’t believe we want to go there in restricting patient access.”
  • On the future of the CMS Center for Medicare and Medicaid Innovation: “I believe CMMI is going to be one of the very important legs we have to drive this transformation in our health care system through Medicare. We need to ideate, to pilot, to test and then generalize.”
  • On possible cuts or changes to Medicaid: “I share the commitment to the Medicaid program. It’s a vital safety net program....For many families Medicaid is a vital link or a bridge to independence eventually or a long-term need....and if confirmed, my job will be to make that program as efficient, as effective, as responsive and as available to everybody as possible....I want to make sure that we enable flexibilities for states to run [their Medicaid] programs in ways that meet the needs of their citizens....If we end up looking at any changes on the Affordable Care Act’s Medicaid expansion, I don’t believe any proposals that the president or I would support involve cutting Medicaid or cutting the expansion but rather slowing the rate of growth over the next 10 years in the interest of sustainability....Whether it’s block granting or other changes...you’d have to figure out appropriate formulas and approaches around what’s the amount of money there. I think there is a lot that can appeal from notions of block granting because I do think it helps align incentives better where the states have the empowerment and also the accountability to manage those dollars as their own and...to really be creative and customize the use of the program and stretch it for their citizens.”
  • On a recent OIG report estimating $1.3 billion in rebate losses due to drug misclassifications in the Medicaid Drug Rebate Program: “I was very concerned to...read that report from the Inspector General and I certainly will work with Administrator Verma as well as with CMS to ensure that the program is improved to get at that. One of the key issues I think is to ensure that the regulations and guidance are clear so that those companies knew what their obligation is and if necessary moving to enforcement.”
  • View the full replay at www.finance.senate.gov.

    January 10, 2018
    Medicare Advantage News is about to become Radar on Medicare Advantage

    With the Feb. 1, 2018, issue of MAN, we will adopt a new publication name: Radar on Medicare Advantage. While our focus is still squarely on providing strategies and analysis for Medicare Advantage, Medicare Part D and managed Medicaid, our new name signals a renewed commitment to in-depth, forward-looking coverage. Every issue will bring incisive coverage of the companies, people, catalysts and trends that shape the Medicare industry today and in the future.

    Radar on Medicare Advantage will join our other newly named publications: Radar on Specialty Pharmacy (formerly Specialty Pharmacy News) and Radar on Drug Benefits (formerly Drug Benefit News), available alongside Health Plan Weekly and Health Business Daily. Visit the AISHealth Marketplace for more information about our publications.

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