Daily Archives: September 4, 2018

Part D Prescription plan changes

On Thursday, August 30, the Centers for Medicare & Medicaid Services (CMS) issued two guidance documents to provide clarification to plans participating in the Medicare Part D prescription drug program.

  • Step therapy and Part B drugs: CMS recently announced Part D plans would be permitted to establish “step therapy” programs for Part B drugs starting in 2019. However, CMS’s announcement raised many questions for Part D plans considering participation in this program in 2019. A new Q&A attempts to answer those questions.
  • Indication-based formularies: CMS also released separate guidance that permits Part D plans to develop “indication-based” formularies starting in 2020. Many medications have multiple uses. However, Medicare rules currently require Part D plans to cover a prescription drug without differentiating the conditions for which it is most appropriate. The new rules would change that starting in 2020.

These guidance documents reflect the Trump Administration’s continued interest in reducing prescription drug costs. We expect CMS to announce additional actions in the next several weeks.

Are you getting money back from your Medical Carrier?

Its rebate time in New York. Under the MLR Rules of the Affordable Care act,  Carriers have to return “excess” premiums received.

Oxford- Large Group Rebate only

United Healthcare- Large Group Rebate only

Horizon- no rebate for large groups

Aetna-right now the word is no rebate in NY and NJ large, although they said most likely there will be rebates in small group NY and NJ

Cigna- no rebates

Emblem- no rebates

Empire- no rebates

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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