Taking on Medicare Part D risk: Provider perspective

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By Matthew J. Kramer, Simon Moody, Michael T. Hunter | 12 April 2019
The Centers for Medicare and Medicaid Services (CMS) recently issued a request for comments on the potential use of risk-based arrangements for pharmacy benefits in contracts between Medicare Advantage (MA) plans and contracted providers. CMS noted that risk-based arrangements in contracting for pharmacy benefits may be another tool to drive down the cost of Part B drugs in MA and Part D drugs for MA and Part D plans. This article summarizes the key issues providers need to consider before taking on Part D risk and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.