- Model change impact on the Medicare Advantage 2020 RxHCC risk scores
By Adrian L. Clark, David Koenig | 23 May 2019
This paper summarizes the changes in member risk scores resulting from the revised Medicare Part D risk score model for payment year 2020.
- Removal of safe harbor affects EGWPs
By Stephen Kaczmarek | 02 May 2019
A proposed rule from the Department of Health and Human Services would revise the safe harbor protection in Medicare Part D that currently allows pharmaceutical manufacturer rebates to be paid after the point-of-sale and start requiring such rebates to be credited against the drug’s point-of-sale price.
- Taking on Medicare Part D risk: Provider perspective
By Matthew J. Kramer, Simon Moody, Michael T. Hunter | 12 April 2019
This article summarizes the key issues providers need to consider before taking on Part D risk, an increasingly common ask from Medicare Advantage organizations, and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.
- Hang on tight! Why maintaining a zero-dollar MA-PD premium plan is worth the effort
By Bradley J. Piper, Mary L. Gabe | 08 April 2019
What happens to membership in Medicare Advantage-Prescription Drug plans with a zero-dollar premium when a premium is added?
- Impact of offsetting midyear list price and rebate reductions in Medicare Part D
By David R. Mike, Matthew Hayes, Stephen Amend | 05 April 2019
The structure of the Medicare Part D program produces interesting, and sometimes counterintuitive, financial outcomes when drug list prices are decreased and rebates are eliminated.
- Medicare Advantage Uniformity Flexibility benefit offerings
By Julia M. Friedman | 25 March 2019
A review of the Uniformity Flexibility benefits offered during the contract year 2019 plan year to provide insight into the market dynamics regarding this new benefit design.
- What’s in the Part D Payment Modernization Model Request for Application: More questions than answers
By Nicholas Johnson, Tracy A. Margiott, Matthew Hayes, Adam Barnhart | 08 March 2019
With less than one month to respond, many details unknown, and multiple impending changes to the Part D program, the Part D Payment Modernization Model’s Request for Applications leaves more questions than answers.
- Pathways to Success MSSP final rule: Financial benchmark
By Jill S. Herbold, Cory Gusland, Charlie Mills, Matthew J. Kramer | 22 February 2019
This paper discusses the changes to the financial benchmark methodology that measures the gross savings or losses of an accountable care organization under the Medicare Shared Savings Program.
- The Medicare Advantage Value-Based Insurance Design Model: Overview and considerations
By Catherine M. Murphy-Barron, Pamela M. Pelizzari, Brian Regan | 19 February 2019
This research brief describes the Value-Based Insurance Design model for Medicare Advantage organizations (MAOs) and explores key considerations for eligible MAOs considering participation in the model.
- An end to manufacturer rebates as we know them today?
By Deana Bell, Jennifer Carioto, Matthew Hayes | 15 February 2019
The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.