ACS CAN Comments on Medicare Part C and D Proposed Rule

January 17, 2018

On January 16, 2018, ACS CAN filed comments in response to CMS’ proposed rule implementing changes to the Medicare Part C and Part D programs. ACS CAN commented on a number of proposed policies:

  • CARA Implementation: CMS proposed to implement a number of policies as required under the Comprehensive Addiction and Recovery Act (CARA), which requires Medicare Part D plans to limit access to opioids for beneficiaries deemed at-risk for misuse or abuse. ACS CAN raises a number of questions related to how this policy will be implemented for cancer patients and ask CMS to issue clarifications.  
  • Medicare Advantage (MA) Plan Flexibility: CMS proposed to allow MA plans additional flexibility to reduce cost-sharing for certain benefits for its enrollees. ACS CAN is generally supportive of the proposal, but cautioned that CMS should engage in careful monitoring to ensure that plans aren’t using the flexibility to increase costs to beneficiaries.
  • MA Plan Segments: CMS proposed to allow MA plans to vary the benefits they provide within a given service area. ACS CAN urged CMS to not adopt this policy because it could be confusing to beneficiaries.
  • Meaningful Differences Requirements: CMS proposed to eliminate the requirement that one entity offering multiple MA plans in a given region must make sure the plans are meaningfully different from each other. ACS CAN noted that while we appreciate the rationale behind the policy, we do not believe the proposed change is necessary given the robust plan offerings currently available to beneficiaries.
  • MA Plan Opt In: CMS proposed to allow plans that offer a robust line of business (e.g., commercial/employer-sponsored coverage/Medicaid managed care plans AND an MA plan) the ability to enroll a person into an MA plan sponsored by the entity when the person becomes eligible for Medicare. ACS CAN agreed with the intent of the policy (e.g., facilitated enrollment in the Medicare program) but expressed concern that it would unfairly steer beneficiaries to particular plan offerings.
  • Part D Tiering Exceptions: CMS proposed to clarify its rules requiring a beneficiary’s eligibility for a tiering exception (e.g., when the beneficiary has a medical need for a particular drug and has a medical reason why he/she is unable to take the lower-tiered product). ACS CAN expressed support for this proposal.
  • Limitations on the Special Enrollment Period (SEP) for Low-income Subsidy (LIS) Beneficiaries: CMS proposed to limit the ability for LIS beneficiaries to switch Part D plans mid-year. ACS CAN urged CMS not to adopt the policy at this time because these beneficiaries may need to switch plans if their current plan undergoes a mid-year formulary change.
  • MA Quality Rating System: CMS proposed to require that quality reporting be done at the plan rather than organizational level. ACS CAN supported this provision because it would more accurately reflect the quality of care provided to beneficiaries. CMS also proposed new policies regarding the adoption of new quality measures. ACS CAN is concerned that the proposed policy would result in a lag time between when the quality measures are first proposed and when they are actually implemented by CMS.
  • Midyear Formulary Changes: CMS proposed to allow Part D plans greater flexibility to implement mid-year formulary changes. ACS CAN urged CMS to reconsider this proposal.
  • Request for Information on Manufacturer Rebates and Pharmacy Price Concessions: Included in the proposed rule is a request for information (RFI) on requiring Part D plans to include a minimum percentage of manufacturer rebates and pharmacy price concessions be included in the negotiated price at the point of sale. CMS does not propose specific regulations, but rather is using the proposed rule as an opportunity to solicit comment that will be used for future rulemaking. ACS CAN is generally supportive of the policies outlined in the RFI.