Medicare Policies for 2019: What You Need to Know

Apr 10, 2018 / Amanda Chase, Horsesmouth Assistant Editor

On April 2, the Center for Medicare and Medicaid Services (CMS) announced its finalized policies for health and drug plans in 2019. Its aims are to lower the cost of drugs for beneficiaries and to provide additional plan choices. Here are 5 takeaways from the policies, as analyzed by the American Journal of Managed Care.

  1. Tackling prescription drug prices. CMS has reduced the maximum amount that low-income beneficiaries pay for biosimilars and allowed certain certain low-cost generic drugs to be substituted onto plan formularies at any time during the year. To promote competition, it is removing the requirement that certain Part D plans have to "meaningfully differ" from each other, and increasing the number of pharmacy options available.
  2. Expanding the definition of "primarily health-related." The standards for health-related supplemental benefits for MA plans have been reinterpreted, and expand significantly the list of allowed services and items, including things that may not be directly considered medical treatment.
  3. Opening the door for vendors such as Amazon and Walmart to work with health insurers. The expanded definition of "health-related" could lead to insurance companies looking to address the social determinants of health, which could translate into partnerships with companies such as Amazon, Walmart, or Uber.
  4. Addressing the opioid epidemic. According to CMS, new policies provide Medicare with additional tools to combat opioid overprescribing and abuse, as well as protect families and communities nationawide. Among these new policies is permission for Part D sponsors to require beneficiairies at risk of addiction or overuse to use only selected prescribers or pharmacies.
  5. Patients Over Paperwork initiative. This initiative works to remove regulatory obstacles and empower patients to make informed health care decisions. New policies allow the agency to use electronic posting for bulky disclosures and streamline government review and approval of marketing materials. Additionally, the agency will improve the transparency of Star Ratings for MA plans, to increase the weight given to patient experience and access.


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