A 10 percent reduction in reimbursements for Medicare physicians could be delayed for 18 months, if Democratic Congressman Max Baucus’s plan is successful. (Kaiser Network)
Medicare physicians will see their reimbursements cut by 10 percent beginning July 1, 2008. Under Baucus’s plan, the cut would be delayed until 2010, and reimbursement rates would be raised by 1.1 percent. He also wants to increase and link reimbursements for primary care physicians (PCP) to quality of care.
The Medicare Payment Advisory Commission, an independent government agency that advises Congress about Medicare issues, believes that a pay increase for PCPs will “bolster the number of PCPs, who receive relatively lower salaries than specialists, causing fewer medical students to choose primary care…”
In other Medicare news, a survey released by the Pharmaceutical Care Management Association (PMCA) revealed that reducing the time in which Medicare prescription drug reimbursements must be made would limit the ability to detect fraud. From the Kaiser Network:
For the survey, PCMA interviewed dozens of industry experts responsible for pharmacy audits and fraud investigations and found that fraud schemes have become more complicated and more difficult to detect. Experts maintain that waste, fraud and abuse in pharmacy claims accounts for 1% of medication costs, which could translate to hundreds of millions of dollars in unnecessary costs for the Medicare prescription drug benefit, PCMA said.
On Monday, the Centers for Medicare and Medicaid Services (CMS) announced new rules that will allow low-income Medicare Part D prescription drug program beneficiaries to remain enrolled in their current plans instead of facing reassignment at the end of the year. The new rules will be effective May 31, 2008. (Source)
The new rules apply to beneficiaries eligible for the low-income subsidy under Part D. Under the existing rule, beneficiaries in plans that charge no premium are automatically switched to another no-premium plan if their current plan decides to start charging a premium. Switching over may cause disruption in coverage.
Kerry Weems, CMS Acting Administrator, said, “It’s important that we provide stability and predictability in the prescription drug program, particularly for the beneficiaries who receive Medicare’s extra help. By changing the method that we use to determine the benchmarks for the low-income subsidy, we are able to ensure that there will continue to be a wide choice of zero-premium plans available to these beneficiaries.”
For more information, you may download a PDF copy of the 28-page final regulation.
According to a Government Accountability Office (GAO) released last month, the Centers for Medicare and Medicaid Services (CMS) may have made $90 million worth of “questionable” payments to Medicare Part D contractors hired to help launch the program. (Kaiser Network)
Some payments didn’t comply with terms of the contracts, the GAO found. Jeff Nelligan, CMS spokesperson, said launching the Part D program “required some contract decisions outside of standard policy.” You may download the 74-page report here (PDF).
GAO issued a second report which revealed that states covering adults under the State Children’s Health Insurance Program (SCHIP) are more likely to have budget shortfalls than states that do not. Jocelyn Guyer, a deputy executive director of the Center for Women and Families at Georgetown University, told CQ HealthBeat that the Clinton and Bush adminstrations encouraged states to cover adults under the program.
For more information, download the 50-page report here (PDF).
Open enrollment in the Medicare Part D prescription drug plan for 2008 begins November 15 and runs through December 31. Those who miss the deadline will have to wait until the next enrollment period.
Medicare Part D, which began on January 1, 2006, was designed to give Medicare-eligible individuals more coverage options for prescription drugs.
Providers looking for more information about Part D can find resources at the Centers for Medicare and Medicaid Service’s Medicare Learning Network drug coverage page.
According to a new study published in the Health Affairs journal, Medicare Part D has “dramatically reduced” the number of beneficiaries caught in the coverage donut hole.
The donut hole, also known as the coverage gap, is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out-of-pocket. Over 16,000 seniors were surveyed last fall, and a quarter of respondents said they spent $100 or more out-of-pocket on Part D drugs per month, and 8 percent reported spending more than $300 a month.
Stuart Guterman, senior program director for the Program on Medicare’s Future at the Commonwealth Fund, said, “For beneficiaries with chronic conditions, out-of-pocket costs can be a major expense…There is a tendency to view Part D as mission accomplished…I think it is important to understand that this is going to take a continued effort to try and reach the folks who are harder to reach, particularly the low-income folks, and to improve the protection the benefit offers to all seniors.”
You may download a copy of the study in PDF here.
Earlier this week, the Centers for Medicare and Medicaid Services (CMS) announced that it will limit Medicare coverage for anemia medications in cancer patients. CMS will cover medications to treat anemia caused by chemotherapy but won’t cover medications for anemia caused by cancer. (Kaiser Network)
Roger M. Perlmutter, a physician and spokesman for the drug company Amgen said, “The coverage restrictions placed on the FDA-approved indication have no scientific basis and are incompatible with good clinical practice…Moreover, through this coverage decision, the CMS has undermined the ability of physicians to decide how best to administer ESA therapy to their patients through carefully defined dosing guidance articulated by the FDA.”
In other Medicare news, CMS issued new rules last year that would allow denial of coverage through Medicare Part D for drugs prescribed for off-label uses, according to the Medical Rights Center.
Jeffrey Kelman, chief medical officer for Medicare’s Center for Beneficiary Choices, told USA Today that Medicare rules do allow patients to get prescriptions for off-label drugs, but the drugs must appear in drug reference guides as useful to their condition. “There has to be some reason for using (the drugs),” Kelman said.
Earlier this month, the U.S. House of Representatives passed a bill that would require the government to negotiate Medicare Part D prescription drug prices with drug companies. (See Congress Debates Medicare Part D Drug Price Negotiating)
Last week, the measure failed to receive enough for votes for a floor debate in the Senate. (Medical News Today) Those who oppose the bill fear that requiring the government to negotiate instead of allowing the market to dictate drug prices will stifle drug research and development.
Senator Harry Reid, a Democrat, told the New York Times, “The Department of Veterans Affairs is able to negotiate for lower-priced drugs. HMOs can negotiate. Wal-Mart can negotiate. Why in the world shouldn’t Medicare be able to do that?”
Texas Republican John Cornyn said the drug price negotiation bill was a “step down the road to a single-payer, government-run health care system.”
House Speaker Nancy Pelosi vowed to keep pushing the bill. She told The Hill that her party “will keep fighting until this bill is signed into law and seniors and people with disabilities have access to affordable prescription drugs.”
All 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands will share $30 million in grant money to provide health insurance counseling services to Medicare beneficiaries, according to the Centers for Medicare and Medicaid Services. The State Health Insurance Assistance Programs, or SHIPs, will help beneficiaries figure out which insurance coverage is best for them. The program should be quite helpful for Medicare Part D enrollees.
Under SHIPs, counseling will be more personalized. For more information, see the press release.
Congressional discussions about the government negotiating Medicare Part D drug prices is ongoing.
Although President George W. Bush has threatened to veto legislation allowing the government to negotiate prescription drug prices, lawmakers are moving forward. The House of Representatives passed a measure that would require the secretary of the Department of Health and Human Services to barter with drug companies over Medicare Part D drug prices. (UPI)
The Senate version of the bill is less extreme. It won’t require the secretary to negotiate drug prices but will allow him to negotiate. As expected, the drug industry is lobbying against the legislation. From the article:
The pharmaceutical industry has also kicked into high gear, spending $182 million on lobbying between June of 2005 and June 2006, according to the Center for Public Integrity…Touting a recent Congressional Budget Office report that found negotiations would result in negligible savings, the industry is pushing its message that interfering with the prescription drug benefit now would hurt consumers.
The Centers for Medicare and Medicaid Services (CMS) announced that payment rates for Medicare Advantage plans will increase by 3.5 percent in 2008. (CQ Health Beat News)
Medicare Advantage plans offer beneficiaries the traditional fee-for-service program with the option to receive Medicare through private insurance plans like health maintenance organizations and preferred provider plans.
CMS also announced updates to Medicare Part D. The new annual percentage increase used for updating features like the deductible, the initial coverage limit, and the out-of-pocket threshold for the standard benefit is 4.64 percent for 2008. For updating the maximum co-payments below the out-of-pocket threshold for certain dual eligibles, the percentage increase is 2.42 percent.