Topic: Part D

PBM Performance on Medicare Part D Won’t Improve Anytime Soon

John Gorman

It was a YUGE week in the pharmacy benefit manager (PBM) sector, with billions of dollars in contracts changing hands and PBM industry volatility increasing.  It all means PBM performance on Medicare Part D won’t improve anytime soon, and health plans must be more vigilant than ever that their top vendor could walk them into a compliance buzzsaw.

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Why are the Dual Eligible Demos Such a Hot Mess?

John Gorman

There’s no avoiding the steady stream of bad news facing the Centers for Medicare & Medicaid Services (CMS) financial alignment demonstrations for dually eligible beneficiaries. Enrollment is declining, beneficiaries are opting out at epic rates, and leading states like California are slowing their efforts despite crushing budget realities.  Dozens of health plans have invested millions to participate in what’s become a hot mess.  Where do we go from here?

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The Effect of the New Part B Drug Payment Proposal on Medicare Advantage and Part D

Olga Walther

It’s no secret drug costs have skyrocketed in the past decade, and drug payment policymakers face an uphill battle in figuring out how to curb this exponential growth. The Centers for Medicare & Medicaid Services (CMS) has already taken a beating on its proposal to test a new alternative payment design to pay for drugs covered under Medicare Part B, calling into question whether this new methodology will go through looking anything like originally proposed. Part B spending is just a fraction of drug spending in Medicare, covering the drugs administered by a physician or hospital outpatient department. A major question for our industry is what effect this new proposal will have on Medicare Advantage (MA) and Part D plans if implemented.

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What a Clinton Administration Could Mean for Government Health Programs

John Gorman

So the people spoke and we are heading for an epic cagematch smackdown general election between reality TV star Donald Trump and former Senator and Secretary of State Hillary Clinton.  And you’re asking, what’s going to happen to Medicare, Medicaid and ObamaCare? The answer is plenty — below the waterline and out in the states.  Stakeholders will need to pay attention or get left behind.

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50/50 Just Won’t Cut It – You Have to Commit 100%. The Top 5 Components for Successful, Compliant, Committed Operations

Julie Billman

If you weren’t able to make it to the Gorman Health Group 2016 Forum this year, you missed a dynamic time. More than just relevant topics, it included engaged participants who added a wealth of depth to our discussions. The topic garnering a lot of audience participation was “Can Operational Efficiencies and Compliance Co-Exist?”  The struggle to align the two is real and takes constant, diligent effort, but the success it can create is priceless.

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Takeaways from the Gorman Health Group 2016 Client Forum

John Gorman

The Gorman Health Group 2016 Forum concluded last week with over 200 of our closest clients and partners. There was great news and rough news, so here are a few takeaways: Read more

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CMS Largely Holds Firm on Most Proposed MA Payment & Policy Changes for 2017

Olga Walther

On April 4th, the Centers for Medicare & Medicaid Services (CMS) issued the Final Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies, and 2017 Call Letter. This is the final notice of changes in rates of payment and overall policy.

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