This white paper highlights why plan sponsors might want to take another look at participating in the Medicare Part D Payment Modernization (PDM) Model. The PDM Model is a five-year, voluntary demonstration program, currently in its second year. While thus far participation has been very limited, the article covers some changes that could shift thinking: increased formulary flexibility, the possible removal of shared downside risk, and the potential for point-of-sale (POS) rebates in 2023. The article discusses how the PDM Model works, what formulary flexibility is available, and other PDM Model flexibilities for participating plans. The white paper also covers what barriers exist to decrease federal reinsurance spending, what else plans should consider, and next steps for interested plan sponsors.
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Is it worth revisiting the Medicare Part D Payment Modernization (PDM) Model?
Is it worth revisiting the Medicare Part D Payment Modernization Model?
Adam Feller, Kate Herbig, Kevin Pierce, Matthew Hayes