Medicare Advantage pay to jump as enrollment grows

Published by McKnight’s LTC News

Medicare Advantage plans will receive a 3.4% uptick in federal payments in 2019. That’s nearly 90% more than the 1.84% increase proposed in February.

Notice of the bigger raise came in the Centers for Medicare & Medicaid Services’ 2019 final rate notice and call letter released in April. As many as one-third of Medicare beneficiaries were enrolled in a managed care plan last year, with enrollment running about 7% higher this year, according to Bloomberg Intelligence.

The 2019 revisions include several policies designed to lower drug costs, an effort lauded by Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition.

“Based on preliminary review of more than 1,000 pages of new regulation and guidance, the Senior Care Pharmacy Coalition appreciates CMS’ sensitivity to the characteristics of the long-term care patient population in finalizing new Part D regulations and the 2019 Call Letter,” said Rosenbloom. “We are particularly gratified that the agency modified opioid control provisions based on the unique characteristics of long-term care patients and the heightened controls that long-term care pharmacies provide.”

Rosenbloom continued to press for scrutiny of how Part D plans and their affiliated pharmacy benefits managers impose “inappropriate” fees on long-term care pharmacies.

“We look forward to the Trump administration’s anticipated plan to respond to high drug prices,” he added.

Plans will be able to add generic drugs to their formularies at any time during the year, and increase the number of plan options available.