CMS Issues Final Rule for MA and Part D Drug Programs

The announcement aligns with the Biden Administration’s push to emphasize health equity through policy.

Federal officials have issued a final rule for Medicare Advantage (MA) and Part D prescription drug programs, saying it will make the lives of dually eligible beneficiaries easier, provide enhanced transparency, and continue to promote the Biden Administration’s top health-related priority: advancing health equity.

“The Biden-Harris Administration has remained committed to ensuring equity in healthcare for all,” Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure said in a statement. “This rule improves the healthcare experience and affordability for millions of people with MA and Part D coverage, including dually eligible individuals, and provides needed support to populations often left behind.”

Officials said the final rule finalizes provisions to provide more affordable access to care for 53 million Americans enrolled in Medicare health or drug plans.

First, according to the announcement, Medicare Part D beneficiaries will gain access to reduced out-of-pocket costs for prescription drugs starting in 2024, resulting from a new requirement that Part D plans pass along price concessions received from pharmacies at the point of sale. Second, the final rule clarifies policies to provide beneficiaries enrolled in MA plans uninterrupted access to necessary services during disasters and emergencies – such as the COVID-19 pandemic.

Officials said one more intent of the final rule is to address what they labeled “fragmented care” for the approximately 11 million individuals dually enrolled in Medicare and Medicaid. Specifically, officials said, they are codifying a mechanism through which states can require dual-eligible special needs plans to use integrated materials that make it easier for such beneficiaries to understand the full scope of their benefits.

“Dual eligibility is also a predictor of social risk and poor health outcomes,” CMS said in a press release. “Many dually eligible individuals experience challenges such as housing insecurity and homelessness, food insecurity, lack of access to transportation, and low levels of health literacy.”

CMS said the final rule is expected to help reduce health disparities by “delivering person-centered integrated care that can lead to better health outcomes for enrollees and improve the operational functions of these programs.” The final rule also requires all MA special needs plans to annually assess certain social risk factors for their enrollees.

Additionally, CMS said it is reinstating the requirement that MA and Part D plans inform enrollees of the availability of free interpreter services. Plans will also be required to include multi-language inserts in all required documents provided to enrollees, and the agency said it is closing a loophole for dually eligible MA enrollees who have high medical costs that exceed the maximum out-of-pocket limit established by the MA plan (which previously resulted in lower payments to providers serving dually eligible MA enrollees than providers serving non-dually eligible MA enrollees).    

Finally, CMS said it is reinstating medical loss ratio reporting requirements and expanding reporting requirements for MA supplemental benefits – something it hopes will improve transparency into MA and Part D plans’ underlying costs, revenue, and supplemental benefits.

“Fiscal stewardship is a central principle of the work we do every day,” CMS Deputy Administrator and Director of the Center for Medicare Dr. Meena Seshamani said. “As responsible stewards of the program, this rule enables us to learn more about how the Medicare dollar is being spent on certain Medicare Advantage benefits, such as housing, food, and transportation assistance, in order to better understand how we can most effectively support the health and social needs of people with Medicare.”

To view a fact sheet on the final rule, go here.

The final rule can also be downloaded from the Federal Register in its entirety here.