The Medicare Payment Advisory Commission (MedPAC) recently proposed revisions to the Medicare Part A post-acute care and Medicare Part D outpatient drug benefits. A final report to Congress detailing these recommendations will be published in June 2016. During its March 2016 meeting, MedPAC staff explained that MedPAC will recommended a single payment for all post-acute care providers based on a patient’s clinical condition and not on facility setting (skilled nursing, home health agency, etc.). MedPAC’s proposed Part D changes are designed to “continue to meet the goals of providing beneficiaries with access to needed medications while remaining financially sustainable in the changing health care environment.”
For Part D, MedPAC provided the following three categories of recommendations:
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Change the Medicare Part D benefit to lower Medicare’s individual reinsurance subsidy from 80 percent to 20 percent, exclude manufacturers’ discount in the coverage gap from enrollees’ true out-of-pocket (TrOOP) spending, and eliminate estimated cost sharing above the out-of-pocket threshold.
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Change the Medicare Part D benefit by modifying the low income subsidy (LIS) copayment for beneficiaries with incomes at or below 135 percent of poverty to encourage the use of generic drugs, reduce or eliminate cost-sharing for generic drugs, and assess therapeutic classes at least every three years.
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Streamline formulary changes, remove antidepressants and immunosuppressants for transplant rejection from the six protected classes that require prescribers to provide more rigorous supporting statements when applying for exceptions, and permit plan sponsors to use certain tools to manage specialty drug benefits.
Although MedPAC’s recommendations have been met with some criticism in the industry, on April 7, 2016, MedPAC’s Medicare Part D outpatient drug benefit recommendations were unanimously approved by a panel that advises Congress on Medicare payment policy.
Among MedPAC’s findings in recommending a single post-acute care prospective payment system (PAC PPS), the Commission does not believe that there should be special payment provisions for rural providers but does recommend further study on higher payment rates for low-volume providers and for providers that treat patients with particularly high acuity.
To view the March 2016 MedPAC meeting transcript, click here.
Reporter, Stephanie F. Johnson, Atlanta, (404) 572-4629, sfjohnson@kslaw.com.
