CMS Updates Medicare Marketing Guidelines, Opening Additional Doors to Plan Sponsors

August 19, 2019

CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

By Lauren Flynn Kelly

CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

Although CMS at press time hadn’t posted a redlined version of the complete 2020 document, an Aug. 6 memorandum from the CMS Medicare Drug & Health Plan Contract Administration Group highlighted the various updates, including the deletions from 2019, and urged plans to cross-reference the memo with the existing MCMG.

“The deletions are more important than the insertions,” says Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official. “Probably the most important deletion concerns the prohibition on holding back-to-back educational and marketing events. This seems to open the door to piggybacking marketing sessions on educational events.”

Last year’s MCMG expanded what can happen at educational events by allowing plan representatives to set up future marketing appointments and hand out business cards and contact information for beneficiaries to initiate communications. But by deleting the word “future” and the stipulation that representatives “may not conduct a marketing/sales event immediately following an educational event in the same general location,” it appears that CMS may allow plans to set up marketing appointments immediately after an educational event, says Kelli Back, a health care attorney in Washington, D.C.

Another example of important “deletions” is around RI programs, for which marketing no longer has to be done “in conjunction with information about plan benefits,” nor does it have to include information about all RI programs offered by the MA plan.

People on the Move

August 16, 2019

Average Medicare Part D Base Beneficiary Premium Declines for Third Straight Year

August 16, 2019

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.

by Jinghong Chen

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.


SOURCE: CMS. Visit https://go.cms.gov/2arFZfX. Infographic compiled by AIS Health.

Datapoint: Centene Expanding 2020 Exchange Offerings in 10 States

August 15, 2019

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Source: AIS’s Directory of Health Plans

More Than 1,000 RM/AT Products Are in Pipeline

August 15, 2019

This past quarter saw two new gene therapies: Novartis AG subsidiary AveXis, Inc.’s Zolgensma (onasemnogene abeparvovec-xioi) received FDA approval May 24 for the treatment of spinal muscular atrophy, and bluebird bio’s Zynteglo (autologous CD34+ cells encoding βA-T87Q-globin gene) received conditional marketing authorization from the European Commission for transfusion-dependent beta thalassemia.

While only a handful of therapies in the broader regenerative medicine/advanced therapy (RM/AT) space are available globally, a new report shows that is likely to change, as there are more than 1,000 products in the pipeline.

By Angela Maas

This past quarter saw two new gene therapies: Novartis AG subsidiary AveXis, Inc.’s Zolgensma (onasemnogene abeparvovec-xioi) received FDA approval May 24 for the treatment of spinal muscular atrophy, and bluebird bio’s Zynteglo (autologous CD34+ cells encoding βA-T87Q-globin gene) received conditional marketing authorization from the European Commission for transfusion-dependent beta thalassemia.

While only a handful of therapies in the broader regenerative medicine/advanced therapy (RM/AT) space are available globally, a new report shows that is likely to change, as there are more than 1,000 products in the pipeline.

The Alliance for Regenerative Medicine published the report, titled Quarterly Global Regenerative Medicine Sector Report: Q2 2019, on Aug. 1. It shows there are 1,069 clinical trials using specific RM/AT technologies, which include gene therapy, gene-modified cell therapy, cell therapy and tissue engineering. Ninety-four of those products are in Phase III trials.

While Zolgensma’s $2.125 million price for a one-time infusion makes it the costliest drug on the planet, many other newer RM/AT products are certainly not cheap. Though many manufacturers are offering various reimbursement schemes, including rebates if a therapy doesn’t work, other outcomes-based deals and multiyear pay-over-time payment options, experts note that many barriers exist in the execution of these strategies.

“In principle, spreading the cost over a five-year period and putting the cost installments at risk based upon efficacy is a good approach,” says Winston Wong, Pharm.D., president of W-Squared Group, about Zolgensma. “However, the devil is in the details. Do we have the systems in place that have the capability to administer a five-year contract?”

According to Wong, “From the manufacturer perspective, a value-based contract implies that no payment would be made if the patient relapses or passes on. Systems are not in place to have the ability to track the patient once therapy is administered.”