On March 4, NASP wrote a letter to CMS Deputy Administrator & Director Sean Cavanaugh regarding the Methodological Changes for 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies. NASP also provided definitions of specialty pharmacy and offered comments about the Call Letter.
NASP comments on the organization’s concerns over the CMS proposed plan.
NASP provides a point-by-point summary of comments made on the 2017 CMS Call Letter and the agency’s response.
On April 6, 2015 CMS issued the final payment rates and policy changes to Medicare Advantage and Prescription Drug Plans for 2016. On average, the expected revenue change is an increase of 3.25 percent. CMS released the proposed Advance Notice and Draft Call letter on Friday February 20 2015 and accepted comments through Friday, March 6. CMS states in its press release that Medicare Advantage (MA) enrollment has increased 42 percent since the ACA was passed with more than 16 million beneficiaries enrolled, which represents approximately 30 percent of the overall Medicare population. CMS further states that average premiums for MA plans are lower today than they were in 2010, dropping 6 percent between 2010 and 2015.
Download the NASP summary of CMS proposals relevant to specialty pharmacy.
Earlier this week the Centers for Medicare & Medicaid Services (CMS) issued four guidance documents detailing how Medicare Parts B and D as well as the Medicaid Drug Rebate Program will treat biosimilar therapies.
NASP responded to the CMS 2016 Call Letter with concerns about the impact of narrow network strategies on Medicare Part D beneficiary access to specialty medications in the six protected classes. Specifically, NASP commented that a notice period of at least 60 days should be required when a preferred pharmacy is no longer in the network and that CMS should address the often inaccurate information about in-network specialty pharmacies on its Plan Finder web site.
NASP Board members and staff met with CMS staff on January 20 to discuss ways to improve patient access to medications within Medicare’s six protected classes. NASP representatives at the meeting were Board members Duane Barnes, Burt Zweigenhaft, and Mike Agostino, Executive Director Jim Smeeding, and Chief Operating Officer Bob Fulcher.