Final updates to Prescription Drug Program.
Prescription Drug Program: The Center Medicare & Medicaid Services (CMS) released final updates to the Medicare Advantage and Part D Prescription Drug Program for 2018, as an ongoing effort to strengthen the Medicare Advantage and the Prescription Drug Program by supporting flexibility, efficiency, and innovation.
The final policies are similar to the proposal released in February?s 2018 Advance Notice and Draft Call Letter. There are several changes, however, in response to feedback received during the public comment period.
Some of the policies in the rate announcement will according to CMS? April 3 press release will provide:
- Flexibility and incentives to encourage organizations to develop new plan offerings
- Incentives for plans to submit complete encounter data
- Modify the phase-in of the use of encounter data
- Use encounter data for 15 percent of the risk adjustment payment to Medicare Advantage plans
- Help combat overuse of opioids by encouraging safeguards before an opioid prescription is dispensed at the pharmacy
- Employ best practices and the most appropriate care management interventions for enrollees using high dosage opioids
The ?Year-to-Year Percentage Change in Payment? is:
Impact | 2018 Advance Notice |
2018 Rate Announcement |
Effective Growth Rate | 2.8% | 2.7% |
Rebasing/Re-pricing | N/A | 0.3% |
Change in Star Ratings | -0.4% | -0.4% |
MA coding intensity adjustment | -0.25% | -0.25% |
Normalization | -1.9% | -1.9% |
Expected Average Change in Revenue | 0.25% | 0.45% |
Coding trend | 2.5% | 2.5% |
Expected Average Change in Revenue with Coding trend |
2.75% | 2.95% |