Topic: Part D / Prescription Drug Benefits

Center Urges CMS to Preserve and Strengthen Consumer Protections in Medicare Advantage and Part D

We are deeply concerned by ongoing improper payments to MA plans and CMS’ lack of progress in recouping previous payments and deterring future misconduct.

Center Comments on Medicare Advantage and Part D “Transformation Ideas”

While we recognize CMS’ stated intention to maintain benefit flexibility and efficiency throughout the MA and Part D programs, we stress that CMS’ focus should not be on rolling back regulations, reducing oversight or minimizing plan sponsor burdens.

Center Comments on Medicare Advantage and Part D “Transformation Ideas”

While we recognize CMS’ stated intention to maintain benefit flexibility and efficiency throughout the MA and Part D programs, we stress that CMS’ focus should not be on rolling back regulations, reducing oversight or minimizing plan sponsor burdens.

Medicare Part D

This section, while very full of information, is still an introduction to Medicare Part D. For even more details on any of the topics in this section, please click on the links within the topics which will take you to source information.

Center Comments on Draft 2018 Medicare Advantage Call Letter

Despite much attention given to the annual rate notice concerning MA payment, though, we urge CMS to direct more attention to protecting public funds by ensuring that such payment is accurate.  MA “upcoding” – when an MA plan inappropriately reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program – remains an ongoing  problem that policymakers must address. 

Preview – 2017 Part D Standard Benefit & Other Threshold Amounts

Note: The amounts in this table do not apply to beneficiaries who have the Part D Low Income Subsidy (“Extra Help”)

CMA REPORT: MEDICARE COVERAGE FOR OFF-LABEL DRUG USE

While the Medicare prescription drug benefit provides assistance for many people with their drug costs, the requirements for coverage of the off-label use of a drug are onerous and often result in beneficiaries not being able to get the drug coverage they need.

The Center’s Long-Time Concerns Gain Attention

Prescription Drug Pricing and Medicare Advantage Overpayments

Medicare Part D and Off-Label Rx Denials

Coverage denials for Lidocaine and other off-label drugs can be a shock and pose a major problem for people who become Medicare eligible and must transition from an Affordable Care Act (ACA) or a private insurance plan.

Federal Court Issues Favorable Off-label Part D Drug Coverage Decision

The Medicare Advocacy Project of Greater Boston Legal Services recently received a favorable decision from the U.S. District Court in Massachusetts for “off-label” coverage of the drug Dronabinol.

Attention Patients and Prescribers of Part D Drugs

CMS is now delaying enforcement of the Part D Prescriber Enrollment Requirements until February 1, 2017.

Remove Barriers to Obtaining Medicare Covered Drugs

Low income racial and ethnic minority beneficiaries are adversely affected by prescription drug pricing, a problem that has a negative impact on overall Medicare program costs.

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