Newsletter

THREE KEY QUESTIONS ABOUT PART D DRUG PLANS (AKA PDPs) AND THE ROLE OF ANNUAL WELLNESS VISITS WITH A PRIMARY CARE DOCTOR

Following is the essence of remarks T.J. Gibb, President of Medicare Part D at Humana, made about Part D drug plans and the role of annual wellness visits with a primary care physician (PCP):

What should Medicare beneficiaries know about their PDP when seeing their doctor?

To make the most of their visit, members should understand how their plan supports medication needs and overall care. They should know which of their medications are covered, whether prior authorization is required and if lower-cost alternatives are available. By bringing a full list of prescriptions, over-the-counter medications, and supplements with them to their PCP visit, members can help their doctor make informed adjustments, potentially improving adherence and reducing costs. Using their electronic health record (EHR) to capture this information ensures accuracy and makes it easier to share with one’s provider. Additionally, knowing their plan’s preferred pharmacies can help minimize out-of-pocket expenses for both maintenance and acute medications.

What is the importance of strategies to maintain and sustain medication adherence?

Medication adherence is key to managing chronic conditions, preventing complications, and improving health outcomes – ultimately enhancing member satisfaction and plan effectiveness. Use simple strategies like daily reminders, pill organizers and auto-refills to prevent missing doses. Digital tools, such as mobile apps and pharmacy notifications, can also help. Partnering with mail order pharmacies (e.g., CenterWell Pharmacy, Humana’s home delivery pharmacy, Optum Rx, CVS/Caremark, Express Scripts, or other pharmacies as their mail order pharmacy) can further ensure convenient access and potential cost savings for members. Programs like Humana’s Maximize Your Benefit Rx proactively alert members through various online and offline channels when they’ve filled a prescription that has a less expensive option available to them.

How can members make sure they’re taking full advantage of preventive care benefits under their health plan?

It’s important to select a PCP, utilize your medical plan’s preventive care benefits, and ensure you’re maximizing your plan’s capabilities. Many plans offer digital resources and mobile apps, which members can use to track benefits, schedule appointments, and access telehealth services. Members can also schedule proactive reminders about preventive care included in their plan, such as Flu shots.

By utilizing the knowledge about maximizing your PDP benefits during PCP visits, you are empowered to take control of your health, manage costs and stay engaged with your plan.

“GO WILD:” SIXTY DAYS OF HEALTHCARE UNDER TRUMP

This article that appeared in Modern Healthcare on March 21 contains a listing of the most significant actions from the first 60 days of the second Trump administration.  The Administration has made changes to the nation’s healthcare and public health infrastructure but has yet to make major changes to Medicare and Medicaid and has only proposed one significant set of proposals regarding Affordable Care Act administration.

Late in his successful bid to reclaim the White House last year, Donald Trump said his soon-to-be Health and Human Services Secretary Robert F. Kennedy Jr. would “go wild on health.”

The president didn’t wait for Kennedy’s confirmation to get started.

The second Trump administration hit the 60-day mark on March 21. Trump and billionaire Elon Musk, who heads the White House’s “Department of Government Efficiency,” have taken an ax to the Health and Human Services Department and the rest of the federal government.

The action has come at a torrid pace, whipsawing the healthcare sector. Although the administration has yet to make major changes to programs such as Medicare and Medicaid, the first two months of the new Trump presidency has brought significant change to the country's healthcare and public health infrastructure.

Click here for a timeline of the changes (with links including more information on some of the changes) the Administration has made so far.

SITE-NEUTRAL MEDICARE PAY EYED TO FUND TRUMP TAX CUTS

The following appeared in a March 18 article in Modern Healthcare.

While congressional Republicans hunt for hundreds of billions of dollars in healthcare cuts, an old, bipartisan idea seems poised for a comeback: "site-neutral" Medicare reimbursements for outpatient care.

This policy, which the hospital sector opposes and health insurers endorse, would require health systems to charge the same prices for services whether they are performed in a hospital or another location. Lawmakers advanced numerous proposals in 2023 and 2024 that would have implemented some version of site-neutral payment rules, such as barring hospitals from adding facility fees to claims or setting higher prices for services such as telehealth services or off-site drug injections.

The more aggressive ideas could save the government more than $200 billion over 10 years, according to various estimates.

Read the entire article here.

TRUMP KEEPS LEGAL PRESSURE ON INSURERS THROUGH MEDICARE ADVANTAGE CASES

The following appeared in the March 5 issue of Modern Healthcare:

The Justice Department under President Donald Trump is defending the federal government’s position in several Medicare Advantage lawsuits challenging policies that originated during President Joe Biden's term.

Given Trump's overall repudiation of the Biden years and Republicans' generally favorable disposition toward Medicare Advantage and preference for light regulation, Wall Street expected the new administration to take it easier on health insurance companies. So far, in court at least, that's not what's happening.

Since Trump returned to the White House in January, the Justice Department has filed briefs supporting the Biden administration's defenses against companies such as Humana and eHealth in Medicare Advantage cases regarding the Star Ratings quality assessment program, marketing rules and the risk-adjustment system.

Biden oversaw an aggressive campaign to rein in Medicare Advantage insurers that included policies to constrain spending, crack down on misleading marketing, and institute tougher standards for star ratings and quality bonus payments.

Even though Trump is unlikely to continue along the exact trajectory as Biden, his administration will stay focused on how taxpayer money is spent, said Steve Hamilton, a partner at the law firm Reed Smith.

“With this administration, there’s going to be a focus on ensuring that there's less waste and more opportunity to ensure that active participants in the Medicare and Medicaid programs will be using program dollars appropriately,” Hamilton said. That includes defending the government’s position in litigation over Biden-era payment and marketing policies, he said.

Read the entire article here.

About Paul Cholak

Paul is a licensed, independent health and life insurance agent and has over forty years of benefits experience and specializes in helping Medicare beneficiaries obtain health insurance. However, he offers a complete array of life and health insurance products to individuals of all ages.

He guides Medicare beneficiaries through the steps of getting insurance and is available to help clients both BEFORE and AFTER they've made their purchase decision.

Disclaimer for Part C and D plans: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-2048) to get information on all your options."

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