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Mutual of Omaha: Maximize Your Annual Enrollment Period Success

Posted by www.psmbrokerage.com Admin on Wed, Aug 21, 2019 @ 02:43 PM

Maximize your Annual Enrollment Period success!



Annual enrollment provides health insurance producers with an opportunity to write more business in a short window than any other time of year. Make sure you are ready to maximize your success by including Mutual of Omaha’s CareAdvantage HMO (Medicare Advantage) and Mutual of Omaha Rx (Medicare Part D) in your portfolio.

Mutual of Omaha is offering Medicare Advantage plans for Plan Year 2020 in the following markets:

  • Cincinnati (OH/KY) * — Boone, Butler, Clermont, Campbell, Hamilton, Kenton and Warren counties
  • Dallas-Ft. Worth – Collin, Dallas, Denton, Rockwall and Tarrant counties
  • Denver – Adams, Arapahoe, Broomfield, Denver, Douglas, Jefferson, Clear Creek and Gilpin counties
  • El Paso – El Paso county
  • San Antonio* – Bexar county

*Also available for the remainder of Plan Year 2019

  • Mutual of Omaha Rx (PDP) plans are offered in all states except NY and the US territories.

A Few Helpful Tips to ensure for 2020 Success

  1. Get Organized– Don’t let AEP sneak up on you. Get organized before the busy period starts.
  • Become Ready-to-Sell. It’s just 3 easy steps
  • Familiarize yourself with the Mutual of Omaha CareAdvantage Plans and Benefits that are outlined in the Market Overview tear-sheets.  These can be found in Forms & Material on Sales Professional Access (SPA) mutualofomaha.com/broker
  • Organize your client information and reestablish contact if it has been a while
  • Pre-order supplies as they become available
  1. Stay Organized– Make the most of the 54-day AEP period.
  • Plan your work then work your plan
  • Keep track of appointments – it’s easy to get overextended during AEP
  • Make sure you have enough supplies on hand to cover appointments for the upcoming two weeks; or place an order to refresh your supplies.
  • Make use of electronic applications to avoid errors and speed up the enrollment process
  1. Post AEP– Now is the time to take a moment to relax – but just a moment
  • Organize your AEP book of business into a single tracking tool
  • Make yourself a Customer Relationship Manager by keeping in touch with beneficiaries to ensure they understand their benefits and how to use them
  • Watch for other enrollment period opportunities
  • Review your commission statements

AEP is just around the corner.  Are you ready?

Not appointed to sell Mutual of Omaha Medicare Advantage plans? Request details here

Note The plan information described are pending CMS approval and subject to change. Not intended for use as marketing material.  Do not distribute reproduce, edit or delete any portion of this document without the express permission of Omaha Health Insurance Company, Mutual of Omaha Medicare Advantage Company and Medicare Advantage Insurance


Navigating the MA Product Training Site
Ready to Sell Guidelines


Not appointed to sell Mutual of Omaha Medicare Advantage plans? 
Request details here

Additional Updates:
 

Tags: Annual Enrollment Period, Medicare Advantage, Part D, AEP, mutual of omaha

Mutual of Omaha 2020 Medicare Advantage and Part D Market Overview Released

Posted by www.psmbrokerage.com Admin on Tue, Jul 02, 2019 @ 01:33 PM

Mutual of Omaha 2020 Medicare Advantage
and Part D Market Overview Released


 

Mutual of Omaha Medicare Advantage and Part D Market Overview Released

They’re here!! Mutual of Omaha Medicare Advantage Company (MOMAC), Omaha Health Insurance Company (OHIC) and Medicare Advantage Insurance Company of Omaha (MAICO) market overview information has been posted on Forms & Materials on Sales Professional Access (SPA) www.mutualofomaha.com/broker.  This is your opportunity for a sneak peek at the service areas, provider networks and benefits that are anticipated for Plan Year 2020.  You won’t want to miss out on this!

Because plan information is pending CMS bid approval, these documents are available as download only. Also, keep in mind, plan design and service areas are pending government approval and are subject to change. The posted material is for producer use only and cannot be shared with the general public.

AHIP and Product Training

America’s Health Insurance Plans (AHIP) Certification, Medicare Advantage product training and Part D Prescription Drug Plans (PDP) product training is now available on SPA: www.mutualofomaha.com/broker

  • Medicare Advantage – The certification and training links will appear on the MA product page.  To access simply go to Products > Medicare Solutions > Medicare Advantage
  • Prescription Drug Plans – Both of the links appear on the PDP product page. Go to Products > Medicare Solutions > Prescription Drug Plans
  • Please note: If you are taking Medicare Advantage training for the Denver market, you will see a banner that advises you that the product is not available. This is because the new market is pending CMS approval of plan benefits. You can still take the training

Even better, your AHIP Certification results can now be submitted electronically to Mutual of Omaha. No need to fax or mail your certificate. If you have completed the assessment using another carrier, you can still have the results conveniently sent to us. Just navigate to the AHIP site using the link on SPA.  You will find instructions on how to transmit your results electronically. You will not have to pay or take the assessment again.

Not appointed to sell Mutual of Omaha Medicare Advantage plans? 
Request details here

It’s time to get Ready to Sell for 2020 Medicare Products

Get Ready to Sell our Medicare Advantage and PDP products in just 3 easy steps!!  Start the process today.

  1. Contract to sell Mutual of Omaha’s Medicare Advantage and Prescription Drug Plans.
  2. Successfully complete the 2020 America’s Health Insurance Plans (AHIP) annual certification course that meets the requirements established by The Centers for Medicare & Medicaid Services (CMS).
  3. Successfully complete the 2020      Medicare Advantage and Prescription Drug training courses.  There is no cost to take the courses.

That’s all there is to it!

Re-contracting for Mutual of Omaha’s MA market expansion

If you are currently contracted for Medicare Advantage through Mutual of Omaha Medicare Advantage Company (MOMAC), a Medicare Advantage Insurance Company of Omaha (MAICO) Amendment will be required if you are planning to sell outside the current MOMAC markets. This new company is for Medicare Advantage plans rolling out this year in the following markets: Denver, Dallas/Fort Worth and El Paso.

And remember, to earn renewal compensation you will need to be Ready-to-Sell for the plan year compensation is to be paid.


Navigating the MA Product Training Site
Ready to Sell Guidelines


Not appointed to sell Mutual of Omaha Medicare Advantage plans? 
Request details here

Additional Updates:
 

Tags: Annual Enrollment Period, Medicare Advantage, Part D, AEP, mutual of omaha

Medicare Advantage and Part D Commission Rates

Posted by www.psmbrokerage.com Admin on Wed, May 29, 2019 @ 01:48 PM

Contract Year 2020 Agent and Broker Compensation Rate-1

Medicare Advantage and Part D Commission Rates


DATE: 
May 24, 2019

TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, Section 1876 Cost Plans, and Medicare-Medicaid Plans

 FROM: Kathryn A. Coleman / Director

SUBJECT: Contract Year 2020 Agent and Broker Compensation Rate, Referral/Finder’s Fees, Submissions, and Training and Testing Requirements

This memorandum provides contract year (CY) 2020 compensation and referral/finder’s fee limits for agents and brokers, directions for submitting amounts into the Health Plan Management System (HPMS), as well as training and testing requirements.

Compensation Rates and Referral/Finder’s Fees for CY 2020

As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount an organization pays to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by the Center for Medicare and Medicaid Services (CMS).

42 C.F.R. §§422.2274(h) and 423.2274(h) states that referral/finder’s fees paid to independent, captive, or employed agents may not exceed a CMS specified amount. Additionally, referral/finder’s fees paid to independent agents/brokers must be included in FMV for that CY.

The CY 2020 FMV cut-off amounts for all organizations and referral/finder’s fees are as follows:

2020 MA PAY RATES-1


Agent Fair Market Value Payment History:

Year

National

CT, PA, DC

CA, NJ

PR

PDP

2015

408/204

461/230

510/255

280/140

56/28

2016

429/215

483/242

536/268

294/147

63/32

2017

443/222

498/249

553/277

304/152

71/36

2018

455/228

511/256

567/284

312/156

72/36

2019

482/241

542/271

601/301

331/166

74/37

2020

510/255

574/287

636/318

350/175

78/39


NOTE: The FMV amounts for CY 2020 may be rounded to the nearest dollar. The Initial Year amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-year 1.

The renewal amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-years 2 and beyond.

Compensation Rate Submission for CY 2020

As in past years, all organizations must inform CMS via HPMS whether they are using employed, captive, or independent agents.

Organizations that use independent agents must provide the initial and renewal compensation amount or range of amounts paid to these agents.

Additionally, if an organization pays referral/finder’s fees, the organization must disclose the amount. CMS has provided instructions for data entry in the HPMS Marketing Module User Guide.

Organizations must submit their agent/broker information in the HPMS Marketing Module between June 1, 2019 and July 26, 2019, 11:59 pm EST. Please note that CMS does not consider the submission process complete until the organization’s CEO, COO, or CFO has completed the attestation in HPMS.

Organizations that fail to submit and attest to their agent and broker compensation data by July 26, 2019 will be out of compliance with CMS requirements.

Organizations will not be able to make changes to those submissions after the July 26, 2019 deadline.

CMS expects organizations to keep full records documenting that they are updating compensation schedules and paying agents and brokers according to CMS requirements.

Please note that CMS will make the CY 2020 organization-submitted compensation information available for the public to view on www.cms.gov prior to the annual election period for CY 2020.

Curricula for Training and Testing Agents and Brokers for CY 2020

Regulations at 42 C.F.R. §§422.2274 and 423.2274 require that organizations train and test all agents and brokers selling Medicare products, including employees, subcontractors, downstream entities, and/or delegated entities annually on Medicare Parts A, B, C, D, and plan specific information.

CMS further requires that all agents and brokers obtain an 85% passing rate on the test.

In order to ensure the quality of agent and broker training and testing programs, CMS annually provides minimum training and testing requirements to organizations.

Organizations should review these requirements before developing their own agent and broker training and testing programs to ensure compliance with CMS requirements.

CMS permits and encourages organizations and third-party training and testing vendors to include other relevant topics, in addition to the minimum required elements.

PDF Link to announcement

Image: www.Canva.com

Additional Updates:
 

Tags: Medicare, Part D, medicare advantage enrollment,

Spending on Pharmaceuticals to Soar past $370B in 2019

Posted by www.psmbrokerage.com Admin on Wed, May 29, 2019 @ 10:44 AM


Pharmaceutical Spending Will Reach $370B in 2019

Pharmaceutical cost-1

 

U.S. pharmaceutical spending is expected to grow by 2.5% in 2019, topping $370 billion, while overall healthcare spending is projected to grow by 4% and reach $3.6 trillion, according to a Fitch Solutions report released Monday.

By 2023, Fitch Solutions estimates pharmaceutical sales will top $420 billion, account for nearly 1.7% of the national GDP, and 9.7% of overall health expenditures.

Overall healthcare spending is expected to reach $4.3 trillion during the same period of time.

Source: https://www.healthleadersmedia.com/finance/pharmaceutical-spending-top-370b-2019

Additional Updates:
 

Tags: Medicare Part D, Part D, Prescription Drugs

Action required by members who requested to have their premiums withheld by SSA/RRB in 2019

Posted by www.psmbrokerage.com Admin on Mon, May 13, 2019 @ 10:46 AM

Action required by members who requested to have their premiums withheld by SSA_RRB in 2019

 

We want to notify you about an issue affecting all Medicare members who elected to pay plan premiums from their Social Security Administration (SSA) or Railroad Retirement Board (RRB) check.

Aetna Logo-1

Background

Normally, when members select this premium payment option, the SSA/RRB withholds funds from members’ SSA/RRB checks to cover their plan premiums.

Unfortunately, due to a system issue, this did not occur for two or more months starting February 1, 2019. This issue affected all carriers, not just Aetna. Although the system issue is now fixed, the SSA/RRB cannot retroactively deduct premium payments from members’ checks.

What do members need to do?

Because these members now have past-due accounts, their premium payment method has changed to direct billing, effective February 1, 2019. This means they now need to pay any past-due premium amounts to Aetna directly.

Member communication

Members will receive a letter explaining what happened and what they need to do later this month. Letters are being mailed in waves, between May 10-24, so members will receive them over several weeks. View the member letter.

What happens next?

  • We’ve already submitted a new request to restart SSA premium deduction for the affected members, effective June 1, 2019. If the request is accepted by SSA, they will send members a letter of approval. Please be aware this can take up to 90 days.
  • Please explain to your clients that SSA will only deduct future premiums from their Social Security check as of the effective date noted in their approval letter, so any balances owed up until that effective date must be paid to Aetna directly. Members need to pay premiums directly to us for any months the SSA or RRB doesn’t cover.
  • While these members are not currently at-risk for termination due to nonpayment, they do need to begin making payments to ensure their plan does not face termination for nonpayment in the future.

Encourage members to call us with any questions

Although this issue was out of our control, we realize it will be an inconvenience for our members. If they have any questions, please encourage them to call Member Services by dialing the number on their member ID card. The Member Services team is available 7 days a week, from 8 a.m. to 8 p.m.

As always, thank you for your dedication to our members and for your help educating them on this matter. If you have any questions, please contact the Aetna Medicare Broker Services Department at 1-866-714-9301 or brokersupport@aetna.com.

Additional Updates:
 

Tags: Medicare Advantage, Part D, aetna

How Large is Part D

Posted by www.psmbrokerage.com Admin on Thu, Mar 21, 2019 @ 08:51 AM

Partd_drug_coverage


How Large is Medicare Part D?

In less than two decades, Part D has become an industry behemoth

Medicare is second only to private insurance as a major payer for retail prescription drugs. The program’s share of the nation’s retail prescription drug spending increased from 18% in 2006 to 30% in 2018.

 

Percent of Retail Drug Spending, By Payer

percent_retail_drug_spending_by_payer

 

Drugs Covered by Part D and Part B Accounted for 19% of all Medicare Spending in 2016

drugs_coverd_partb_partd

 

Part D Spending is Poised to Escalate

Partd_spending_escalates

 

Read More: https://www.kff.org/infographic/10-essential-facts-about-medicare-and-prescription-drug-spending/

Image: Pexels

Additional Updates:
 

Tags: Medicare Advantage, Part D

Mutual of Omaha: Submitting and Tracking Your PDP Enrollments

Posted by www.psmbrokerage.com Admin on Fri, Nov 30, 2018 @ 01:32 PM

Mutual of Omaha: Submitting and Tracking Your PDP Enrollments



Prescription Drug Plan (PDP) enrollments can be taken via e-App or paper. Below is important information on how to access, submit and track your PDP business.
 
ELECTRONIC ENROLLMENTS

Accessing
The PDP electronic enrollment can be found on Sales Professional Access (SPA- www.mutualofomaha.com/broker). On the left navigation bar under Sales Tools, click:
Electronic Applications – Prescription Drug Plans e-Application – Start or Continue e-App
 
Submitting
Electronic enrollments are submitted electronically at the completion of the application process.

Tracking
If you take an electronic enrollment (started or submitted), click the ‘View Dashboard’ button within the PDP e-app.
 
For CMS approved enrollments, there are two links available to access your report:

  • Click the link labeled ‘Prescription Drug Plan Approvals’ under the ‘Reports’ tab in Sales Professional Access (SPA), or 
  • Click the link ‘Approved Cases’ located on the ‘Electronic Applications’ page under the button to launch the PDP e-app.

 
PAPER APPLICATIONS

Ordering
A PDP enrollment packet can be order through regular channels by faxing the order form or calling Sales Support @ 800-693-6083.
 
Submitting
Completed paper enrollment forms can be submitted to Mutual of Omaha via fax or mail. The Scope of Appointment (SOA) should be retained by the agent and a copy must be submitted to Mutual either via Fax or email.
 
Enrollment Form

  • Fax to: 855-867-6711 (Preferred method of submission); or
  • Mail to: Mutual of Omaha Rx, PO Box 3625, Scranton, PA, 18505-9811

 Scope of Appointment

 All paper enrollment forms MUST be received by Mutual of Omaha Rx’s enrollment processor within 48 hours after the signed enrollment date.
 
Tracking
If you submit a paper enrollment, call 877-775-1360.
 
For CMS approved enrollments, there are two links available to access your report:

  • Click the link labeled ‘Prescription Drug Plan Approvals’ under the ‘Reports’ tab in Sales Professional Access (SPA), or 
  • Click the link ‘Approved Cases’ located on the ‘Electronic Applications’ page under the button to launch the PDP e-app.

Mutual of Omaha Rx (PDP) is a prescription drug plan with a Medicare contract. Enrollment in the Mutual of Omaha RX plan depends on the contract renewal.


Not appointed to sell Mutual of Omaha PDP plans? Request details here

Additional Updates:
 

Tags: Annual Enrollment Period, Medicare Advantage, Part D, AEP, mutual of omaha

Mutual of Omaha: Submitting and Tracking Your Medicare Advantage Enrollments

Posted by www.psmbrokerage.com Admin on Fri, Nov 30, 2018 @ 01:28 PM

Mutual of Omaha: Submitting and Tracking Your Medicare Advantage Enrollments



Medicare Advantage (MA) enrollments can be taken via e-App or paper. Below is important information on how to access, submit and track your MA business.
 
ELECTRONIC ENROLLMENTS

Accessing
Click on the ‘Start New Application’ icon on the Medicare Advantage producer portal. The link to the MA producer portal can be accessed on the Sales Professional Access (SPA- www.mutualofomaha.com/broker) on the Medicare Advantage product page.
 
Submitting
Electronic enrollments are submitted electronically at the completion of the application process.

Tracking
If you take an electronic enrollment (started or submitted), click the ‘View Dashboard’ button within the Medicare Advantage e-app.
 
For CMS approved enrollments click on the ‘App Tracker’ icon within the Medicare Advantage producer portal. 
 
PAPER APPLICATIONS

Ordering
Order the paper enrollment forms from the storefront found under Documents – Resources – Store Front for Supply Orders on the Medicare Advantage producer portal.
 
Submitting
There are two options for submitting completed paper enrollment forms.

  • Producer Online Quick Entry – Log in to the MA producer portal and Select the ‘Start New Application’ icon. Complete the form online and upload your paper documents.
  • Producer Phone Enrollment – Once the enrollment has been completed, you MUST leave the beneficiary’s house. Call Producer Support at 877-259-8657 during business hours (Monday through Friday, 8 a.m. – 5 p.m. CST) and provide details of the enrollment.

 
For both options, the paper documents (enrollment form, SOA and producer checklist) must be mailed to our enrollment processing center within 48 hours of enrollment sign date. A business reply envelope for submitting these forms is provided in each enrollment kit.
 
Tracking
For both paper enrollments you submit and CMS approved enrollments call 877-259-8657. 
 
Mutual of Omaha CareAdvantage is an HMO plan with a Medicare contract. Enrollment in Mutual of Omaha CareAdvantage depends on contract renewal.


Not appointed to sell Mutual of Omaha MA plans? Request details here

Additional Updates:
 

Tags: Annual Enrollment Period, Medicare Advantage, Part D, AEP, mutual of omaha

Humana adds 'grandkids-on-demand' as benefit

Posted by www.psmbrokerage.com Admin on Mon, Nov 19, 2018 @ 09:10 AM

Humana Adds "Grandkids-on-Demand" as Benefit

 
(Photo: Freepik)

Humana Inc. has partnered with a startup called Papa Inc. to provide "grandkids-on-demand" for qualifying members of its Medicare Advantage plans.

Papa is a peer-to-peer service platform — like ride-hailing or short-term-rental services — that connects seniors to vetted college-aged young adults to help them with anything outside of medical or assisted-living needs. Think of things that young adult grandchildren might do for their grandparents, such as light housework, going on walks, running errands or just socializing.

Papa vets and hires young adults through interviews; criminal, background and driving-history checks; and a personality test to ensure the contractors, called Papa Pals, are engaging and sensitive to seniors' needs.

The deal, announced Tuesday, the is another example of Humana's holistic, value-based approach to caring for the seniors it insures. Specifically, the deal is intended to help seniors reduce loneliness and social isolation.

Humana executives said the company's better-than-projected earnings for the third quarter and the year so far were a result of its success in addressing clinical and non-clinical needs of its insurance plans.

“At Humana, we know if we truly want to impact the health of our Medicare Advantage members, we need to look at the whole person, and that includes the social determinants of health, like loneliness and social isolation,” Deb Galloway, president of Humana's Medicare program for Central and North Florida, said in a news release.

Reducing loneliness and social isolation in its members is a big deal for Humana. The Louisville-based health care and health insurance company said in a recently published report that socially isolated seniors are at a much greater risk of developing dementia and Alzheimer's disease; are four times more likely to be hospitalized with in a year of discharge; and are two to five times more likely to die prematurely than seniors with strong social ties.

Papa is headquartered in Miami, Fla., and its services to Humana Medicare Advantage members are currently limited to Tampa region, according to the release. The service is offered for free or at a nominal fee to qualifying Humana members.

In late October, Papa closed a $2.4 million seed funding round that included a lead investment from San Francisco-based Initialized Capital and an investment from Los Angeles-based Sound Ventures, a venture capital firm co-founded by actor and activist Ashton Kutcher, as the South Florida Business Journal reports.

Papa launched its services in late 2017. Seniors can access Papa's services and over 600 contractors by phone, Papa's mobile app or on the company's website.

Source

Additional Updates:
 

Tags: Humana, Medicare Advantage, Part D

HHS Proposes to Link Medicare Part B Payment for Prescription Drugs to International Price

Posted by www.psmbrokerage.com Admin on Mon, Oct 29, 2018 @ 10:40 AM

HHS Proposes to Link Medicare Part B Payment for Prescription Drugs to International Price


Friday, President Trump announced a U.S. Department of Health and Human Services (HHS) plan to test a new payment model that aims to substantially lower the cost of prescription drugs and biologics covered under the Medicare Part B program. The new model would, for the first time, base Medicare payment for Part B drugs on the typically lower prices paid in other countries.

Commonwealth Fund research shows that such bold payment models are needed to tackle high prescription drug prices in the U.S., and that paying international prices might move Medicare and beneficiaries’ drug spending in the right direction. If the proposal moves forward, a number of questions about how it will work need to be resolved, and it’s important to note that Part B spending accounts for just a small slice — 5 percent — of the total national drug bill.

Capture-73

Spending in Medicare Part B

Under Medicare Part B, physicians administer drugs in their offices, often to treat patients with cancer, immunological disorders such as rheumatoid arthritis, and age-related eye conditions like macular degeneration. Medicare’s current payment to physicians, which is based on the average U.S. sales price for these drugs and biologics, is 47 percent higher on average than prices paid by 16 industrialized countries for the same products, according to the administration’s analysis.

Beneficiaries’ cost-sharing is also high for Part B drugs; they pay 20 percent of the Medicare price for each dose. Commonwealth Fund research finds drug costs exacerbate struggles of Americans with serious illnesses, who can face financial ruin even if they have health coverage.

The outline of HHS’s proposed Part B rule, which would be released next spring, reflects an innovative attempt to lower drug spending:

  • Medicare would pay private-sector vendors, such as wholesalers and pharmacy benefit managers, the international reference price called the “target price” for a select set of drugs in its testing areas.
  • Vendors would then negotiate with manufacturers for the drugs and biologics (presumably at lower prices than the payment they receive from Medicare) and supply physicians and hospitals with products.
  • Physicians and hospitals treating Medicare beneficiaries would be required to participate and could choose multiple vendors or change vendors. Medicare would replace its current administrative payment to physicians and hospitals with a flat fee. Currently, providers are paid a percentage of the drug price under Part B. Under the new proposal, they would no longer gain revenue from the price of a drug.
  • Beneficiaries would pay lower copayments to the extent Medicare’s payments are lower.

Several unaddressed details of the Part B model will determine whether it will save Medicare money and lower what beneficiaries pay for their prescription drugs.

Certain features of Medicare and the pharmaceutical market may present stumbling blocks to achieving the model’s goals. For example, how will a target price enable vendors to negotiate with sole-source manufacturers who retain monopoly pricing power? What levers will vendors have in these circumstances? Could global pricing dynamics spur manufacturers to raise prices in other countries in order to raise the Medicare reference price? Answers to these and other questions raised by HHS could reveal limits of the model design.

Total U.S. Spending

Of course, Part B spending is a small portion of total Medicare drug spending, and the bulk of national drug spending falls outside of Medicare. Medicare Part D, for example, which covers drugs dispensed by retail pharmacies, accounts for a much larger share of total U.S. drug spending (27%). Medicare spending for the highest-cost drugs paid under Part D’s catastrophic benefit has grown at an average annual rate of 18 percent since 2007. That is faster than the 9.8 percent drug spending growth under Part B. Leaving Part D out of the proposal therefore leaves a lot of potential savings on the table.

Moreover, prescription drug costs paid by U.S. workers and employers would not be captured under the Part B model. These costs account for a large share of U.S. drug spending. Insurers estimate that prescription drugs now account for 33 percent of employer-paid health insurance premiums, mainly because of high and increasing prices for the same drugs covered by Part B. The Food and Drug Administration (FDA) has announced a series of steps to encourage more price competition from lower-priced products, such as generics and biosimilars. However, FDA actions will need to be coupled with bolder reforms to patent and exclusivity protections that impede U.S. payers from negotiating prices that approximate those achieved by peer countries.

A Broader Strategy

Rather than linking to prices abroad for a slice of U.S. consumers, HHS could pursue a broader strategy that adapts core elements of the international approach to drug pricing. Other developed countries aggregate purchasing power to gain leverage with drug companies, systematically assess the value of individual drugs to inform their purchasing decisions, and enter into a negotiation process with manufacturers that they can stand behind. Adapting these elements to the U.S. would take bold action, but if we did so we could create our own system — one that could achieve the lower drug costs that other countries are able to provide for their residents.

https://www.commonwealthfund.org/blog/2018/medicare-part-b-payment-prescription-drugs-international-prices

Additional Updates:
 

Tags: Part D, medicare updates

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