- A new Part D benefit design? Prescription Drug Pricing Reduction Act proposes major changes to Part D
By Joanna Amend, Samantha J. D’Anna, Dustin J. Grzeskowiak, Justin Harris, Matthew Hayes | 15 August 2019
This article provides an overview of the provisions in the Prescription Drug Pricing Reduction Act of 2019 and the effects on Medicare Part D stakeholders.
- The real-world Medicare costs of Alzheimer disease: Considerations for policy and care
By Bruce S. Pyenson, Charles Steffens | 28 June 2019
This article compares total Medicare-covered (allowed) costs of patients with Alzheimer disease with the risk-adjusted costs of beneficiaries without dementia over their last years of life, using claims data.
- Medicare Advantage enrollment: Growth expectations for new organizations
By Kelly S. Backes, Julia M. Friedman | 26 June 2019
This paper analyzes historical enrollment experience for parent organizations new to the Medicare Advantage market from 2007 to 2018.
- 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.