Medicare Part D Protected Classes Targeted in Last-Minute Payment Demo Update
If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.
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Tactic aims to allow incoming Administration to scrutinize so-called ‘midnight rules’ issued in the final days of the Trump Administration before they take effect. Regulators may also solicit stakeholder comments on delayed rules.
Former CMS acting administrator Andy Slavitt says agency’s direction during Biden administration depends on nominee, but trust fund’s looming insolvency will be ‘an issue you can’t avoid.’ The president’s priorities around health equity, racial justice and mental health will make their way into CMS policy and demonstration models, Slavitt suggests.
Almost a third of Medicare drug plans are expected to offer the insulin demonstration next year, while almost none have signed up for the payment ‘modernization’ demo, under which plans would be at more risk for spending during the catastrophic phase. The Centers for Medicare and Medicaid Services also announces basic Part D premiums will average $30.50 for 2021.