Medicare Advantage & Part D Programs Finalized for 2018

Earlier this month, the U.S. Centers for Medicare & Medicaid Services (CMS) finalized the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs for 2018. According to a press release, CMS confirmed a 0.45 percent rate increase for the Medicare Advantage and Part D programs in 2018. This announcement brought some welcome news for MA organizations and Part D sponsors, and could signal improved transparency by the CMS in its regulation of sponsors.

With its most recent updates, CMS announced its aims to maintain benefit flexibility that allows enrollees to choose the care plan that best fits their individual needs.

“Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” said Seema Verma, CMS administrator. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”

The finalized policies for MA and Part D are similar to those proposed in February (when the proposed increase was 0.25 percent), but underwent some notable changes. The CMS report states that the plans should now see a revenue change of 0.45 percent on average for 2018; however the organization cautions that individual experiences may be different. Additionally, plans should expect a slight change in revenue when calculating expected growth in coding acuity, with the finalized rate up to 2.95 percent (a 0.20 increase from the Advance Notice).

CMS also announced its plans to reward organizations that develop new plans with “innovative” provider network arrangements; they want to incentivize plans that avoid insurers having to jump through hoops. Those plans found to substantially improve patient care will earn higher updates and can improve the benefits offered to enrollees.

Lastly, CMS finalized policies that push back against “the growing national opioid epidemic” by developing safeguards for opioid dispensation at pharmacies. Under the new opioid policy, the release states, Part D sponsors are expected to focus on improving coordinated care among enrollees prescribed opioids, while Medicare Advantage plans that include drug coverage should consider expanding care management services.

CMS is releasing a request for information for Medicare Advantage and Medicare Part D, with comments due by Monday, April 24. The organization is encouraging policyholders and other stakeholders to comment on such options as benefit design or operational flexibility.

“With the new administration, there is an interest in collecting ideas from the public about how we can foster additional innovation,” senior officials said.