MedPAC Votes for Sweeping Revisions to Medicare Part D

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The Medicare Payment Advisory Commission (MedPAC) an important advisory panel to congress, voted to back a package of changes to the Part D prescription drug program that according to MedPAC could save as much as $10 billion over five years. The post-acute proposal will be included in the commission’s June report to Congress and would change the way Medicare reimburses skilled-nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term-care hospitals. The proposal aims to establish rates according to specific patient conditions rather than care setting.

HHS would have until 2022 to develop an actual payment prototype, and MedPAC would need to weigh in on it by 2023. Congress has previously called upon MedPAC to develop a plan to pay the represented providers described above under one prospective payment system.

During discussion, commissioners raised tepid concerns with a few of the recommendations, despite ultimately supporting the recommendations in a unanimous fashion. Commissioners also emphasized the importance of having the Part D recommendations made as a “package,” noting that several of the recommendations are essential to the success of others. For example, Commissioners noted that an improved exceptions and appeals process would be necessary to ameliorate concerns raised about the removal of antidepressants and immunosuppressants from the classes of clinical concern. Additionally, Commissioners cited several recommendations which will require active monitoring to measure the impact on plan sponsors and beneficiary access.

Despite the support of commissioners, providers expressed concerns, especially on the impact the model may have on patients’ out-of-pocket costs. Co-pays currently depend on the post-acute-care setting. Read more…


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