In the consolidating and competitive Medicare Part D market, health insurers should look at preferred networks and enhanced alternative plans as they develop 2015 bids to submit to the Centers for Medicare & Medicaid Services, according to Managed Care Magazine.
Most Medicare beneficiaries support preferred networks, but federal health officials are scrutinizing the adequacy of preferred network access and will reject a Part D bid if the plan's preferred pharmacy network doesn't offer enough pharmacies with preferred cost sharing, Managed Care Magazine noted.
Earlier this year, CMS withdrew proposed changes to Part D, saying it would save healthcare dollars by letting insurers limit how many drugs they cover and how many plans they offer consumers. The proposed rules would have allowed more pharmacies into a plan's preferred pharmacy network as long as they meet the plan's terms and conditions.
Bid development decisions also should take into account the fact that CMS no longer requires enhanced alternative Part D plans to provide additional cost-sharing reductions in the coverage gap for brand and generic drugs. The agency also removed supplemental gap coverage descriptions from marketing materials and its plan finder website, Managed Care Magazine noted.
So when deciding whether to offer enhanced gap coverage, plans should carefully examine the member pool and the regional rates of costly chronic conditions to better gauge member needs, according to the blog post.
Despite scarce supplemental coverage promotions, 94 percent of supplemental Medigap members are satisfied with their coverage and 91 percent would recommend similar coverage to a friend or relative, according to a March survey from America's Health Insurance Plans. Survey respondents said they like limits on out-of-pocket costs, the simplicity of medical bills and related paperwork that comes with their Medigap coverage, FierceHealthPayer previously reported.
To learn more:
- read the Managed Care Magazine blog post