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MedHOK Strategic Insights Blog

CARA Act Implementation Gives Medicare Plans Additional Opportunities to Impact Drug Abuse

In early March, the Centers for Medicare and Medicaid Services (CMS) announced its final rule related to policy changes for Medicare Advantage and Part D plans in 2019. One key point in the rule was implementation of aspects of the Comprehensive Addiction and Recovery Act of 2016 (CARA).

The final rule’s CARA provision seeks to provide an additional tool to help Medicare Advantage (MA) and standalone Part D plans (PDP) to combat the growing opioid epidemic in America.

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Medicare Drug Changes in Store

The Secretary of Health and Human Services (HHS), Alex Azar, indicated recently that major changes in how drugs are administered in Medicare may come soon. The Centers for Medicare and Medicaid Services (CMS) has been increasingly concerned about the high-cost of pharmaceuticals in the program. While drug inflation has tempered, both Part B and Part D drugs are viewed as a major threat to the sustainability of the program over time.

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HHS Secretary Endorses Value-Based Healthcare Transformation

When Donald Trump took office as President in January 2017, many (including this blogger nonetheless) predicted the end of (at least the intense threat to) a quiet transformation to value-based care. There was the following:

  • The intense dislike for government healthcare program expansions in general.
  • The attack on anything Obamacare.
  • The push by the GOP House to “reform” Medicaid by stripping it of the entitlement as well as applying a growth factor to the remake that would have spelled...

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Two Changes Will Have a Major Impact on Medicare Advantage and Part D

Reforms on the horizon mean big changes to financing and service delivery.

If adopted, Medicare Advantage and Part D plans will see two reforms happen on the near-term horizon that will mean major changes to financing and service delivery:

- Overhaul of aspects of Part D retail drug delivery

- Greater flexibility in benefits and services

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2019 CMS Call Letter Is Treasure Trove of New Policies

Due to recent mandate by Congress, the Centers for Medicare and Medicaid Services (CMS) is releasing the Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 Call Letter in two draft notices. The first came in late December and the second in early February. Click Here to review the official release for both Call Letters.

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