Preview: RADAR on Medicare Advantage

HHS Rallies Behind Drug Price Negotiation, Part D Reform

September 16, 2021

As Congress considers expanding Medicare benefits through the budget reconciliation process, a new HHS report expresses the agency’s support for “bold legislative action” to bring down drug prices and outlines a “comprehensive” plan that includes several administrative actions it could take to promote competition among drug companies. Notably, the report calls for legislation allowing HHS Secretary Xavier Becerra to directly negotiate drug prices with manufacturers for coverage under the Medicare Parts B and D programs and to make those prices available to other payers, and the exploration of various concepts by the CMS Innovation Center.

As Congress considers expanding Medicare benefits through the budget reconciliation process, a new HHS report expresses the agency’s support for “bold legislative action” to bring down drug prices and outlines a “comprehensive” plan that includes several administrative actions it could take to promote competition among drug companies. Notably, the report calls for legislation allowing HHS Secretary Xavier Becerra to directly negotiate drug prices with manufacturers for coverage under the Medicare Parts B and D programs and to make those prices available to other payers, and the exploration of various concepts by the CMS Innovation Center.

The HHS Office of the Assistant Secretary for Planning and Evaluation on Sept. 9 issued the report in response to President Joe Biden’s Executive Order on Promoting Competition in the American Economy, which called for a multitude of actions from HHS, including lowering the prices of and improving access to prescription drugs and biosimilars. Meanwhile, lawmakers are considering adding dental, hearing and vision benefits to fee-for-service Medicare as part of a $3.5 trillion spending package that Senate Democrats aim to pass via budget reconciliation, and drug pricing has been viewed as a way to pay for those enhancements.

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With More Online Enrollment, MAOs Must Add ‘Personal Touch’

September 16, 2021

As Medicare Advantage organizations prepare to promote their plans for the 2022 Medicare Annual Election Period (AEP), marketing experts say they see a continued shift to year-round and online campaigns. But with the increased use of digital engagement and enrollment leading to some member dissatisfaction, plans must take extra steps to ensure a positive experience early on, they warn.

CMS as of press time had not yet released its annual “landscape” files for the MA and Part D programs, but data released this time last year indicated that MA beneficiaries in 2021 had an average number of 47 plan choices per county, up from 39 in 2020, and that more than 4,800 MA plans were operating in 2021, compared with 4,300 in 2020. Marketing for the AEP begins on Oct. 1, and open enrollment runs from Oct. 15 through Dec. 7.

As Medicare Advantage organizations prepare to promote their plans for the 2022 Medicare Annual Election Period (AEP), marketing experts say they see a continued shift to year-round and online campaigns. But with the increased use of digital engagement and enrollment leading to some member dissatisfaction, plans must take extra steps to ensure a positive experience early on, they warn.

CMS as of press time had not yet released its annual “landscape” files for the MA and Part D programs, but data released this time last year indicated that MA beneficiaries in 2021 had an average number of 47 plan choices per county, up from 39 in 2020, and that more than 4,800 MA plans were operating in 2021, compared with 4,300 in 2020. Marketing for the AEP begins on Oct. 1, and open enrollment runs from Oct. 15 through Dec. 7.

In her work assisting MAOs with their AEP marketing, DMW Direct Executive Vice President Renee Mezzanotte observes that while last year’s election-related disruptions are behind them, “plans and consumers are still dealing with the uncertainties of COVID.” And that’s not just having an impact on in-person engagement but in the “unexpected channel” of direct mail, she tells AIS Health, a division of MMIT.

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SCAN Ventures Outside Golden State With Ariz., Nev. Offerings

Charts: Top 5 Insurers in Ariz., Nev. MA Markets

September 16, 2021

Following a slew of announcements from Medicare Advantage insurers unveiling new service areas for 2022, SCAN Health Plan on Sept. 9 said it plans to expand its reach beyond California to two new states next year. The Long Beach, Calif.-based insurer currently serves more than 220,000 members in California and is one of the nation’s largest not-for-profit MA plans.

During the upcoming Annual Election Period (AEP), which starts on Oct. 15, Medicare beneficiaries residing in Clark County, Nevada, can enroll in SCAN Health Plan. And in the Arizona counties of Maricopa, Pima and Pinal, individuals can sign up with SCAN Desert Health Plan. UnitedHealthcare currently dominates both markets, followed by Humana Inc. (see charts below). In addition, SCAN’s MA plans will be available in two new California counties — Alameda and San Mateo — enabling it to reach more than 5 million potential customers across 17 markets in three states. SCAN will communicate with potential customers in five different languages, including English, Spanish, Korean and Chinese.

Following a slew of announcements from Medicare Advantage insurers unveiling new service areas for 2022, SCAN Health Plan on Sept. 9 said it plans to expand its reach beyond California to two new states next year. The Long Beach, Calif.-based insurer currently serves more than 220,000 members in California and is one of the nation’s largest not-for-profit MA plans.

During the upcoming Annual Election Period (AEP), which starts on Oct. 15, Medicare beneficiaries residing in Clark County, Nevada, can enroll in SCAN Health Plan. And in the Arizona counties of Maricopa, Pima and Pinal, individuals can sign up with SCAN Desert Health Plan. UnitedHealthcare currently dominates both markets, followed by Humana Inc. (see charts below). In addition, SCAN’s MA plans will be available in two new California counties — Alameda and San Mateo — enabling it to reach more than 5 million potential customers across 17 markets in three states. SCAN will communicate with potential customers in five different languages, including English, Spanish, Korean and Chinese.

AIS Health, a division of MMIT, spoke with Jill Selby, SCAN’s senior vice president of product development and market expansion, about this milestone move. Editor’s note: This interview has been edited for length and clarity.

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Highmark Expands Public-Sector Presence With Spate of Acquisitions

September 16, 2021

Pennsylvania Blues powerhouse Highmark Health completed a series of acquisitions in 2021 that stand to boost its public-sector membership by nearly 500,000 lives. First, in March, Highmark completed an affiliation deal with HealthNow New York Inc., the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, expanding its reach to the Empire State in several key markets, including Medicare Advantage. Then on Sept. 7, Highmark took full ownership of Gateway Health Plan, the third-largest Medicaid insurer in Pennsylvania. (Highmark originally held a 50% stake in the company). Gateway’s offerings will be rebranded as Highmark Wholecare. With these deals bringing its overall enrollment up to about 4.6 million lives, Highmark has become the fifth-largest Blues affiliate in the U.S., according to AIS’s Directory of Health Plans.

by Carina Belles

Pennsylvania Blues powerhouse Highmark Health completed a series of acquisitions in 2021 that stand to boost its public-sector membership by nearly 500,000 lives. First, in March, Highmark completed an affiliation deal with HealthNow New York Inc., the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, expanding its reach to the Empire State in several key markets, including Medicare Advantage. Then on Sept. 7, Highmark took full ownership of Gateway Health Plan, the third-largest Medicaid insurer in Pennsylvania. (Highmark originally held a 50% stake in the company). Gateway’s offerings will be rebranded as Highmark Wholecare. With these deals bringing its overall enrollment up to about 4.6 million lives, Highmark has become the fifth-largest Blues affiliate in the U.S., according to AIS’s Directory of Health Plans.

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MedPAC: Reforms to Part D LIS Could Produce Savings

September 16, 2021

Although the Medicare Part D program’s low-income subsidy is designed to ensure all beneficiaries have access to drug coverage, the Medicare Payment Advisory Commission (MedPAC) is concerned that the LIS in its current format has the potential to limit competition among benchmark plans and result in higher Medicare spending. As policymakers seek ways to preserve the Medicare Trust Fund while expanding Medicare benefits, LIS reforms could save the program money, MedPAC suggested at its most recent public meeting.

The LIS subsidizes premiums for nearly 13 million Medicare Part D beneficiaries, or 27% of overall Part D enrollees. Spending for LIS premiums in 2019, the most recent year available, totaled $3.8 billion, according to a Sept. 2 presentation by MedPAC Principal Policy Analyst Eric Rollins.

Although the Medicare Part D program’s low-income subsidy is designed to ensure all beneficiaries have access to drug coverage, the Medicare Payment Advisory Commission (MedPAC) is concerned that the LIS in its current format has the potential to limit competition among benchmark plans and result in higher Medicare spending. As policymakers seek ways to preserve the Medicare Trust Fund while expanding Medicare benefits, LIS reforms could save the program money, MedPAC suggested at its most recent public meeting.

The LIS subsidizes premiums for nearly 13 million Medicare Part D beneficiaries, or 27% of overall Part D enrollees. Spending for LIS premiums in 2019, the most recent year available, totaled $3.8 billion, according to a Sept. 2 presentation by MedPAC Principal Policy Analyst Eric Rollins.

MedPAC Suggests Revisiting Benchmark

As the system is currently structured, the benchmark — which is designed to promote enrollment into lower-cost plans — equals the average premium for basic coverage across all stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans in a region, and the premium for each plan is weighted by its LIS enrollment. Enrollees who sign up for basic plans that cost less than the benchmark do not have to pay a premium.

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