Medicare May Fine Advantage Plans For Inaccurate Provider Lists
Elsewhere, a Medicare decision on "preferred pharmacy networks" is met by mostly cheers from industry officials.
Medicare May Penalize Advantage Plans For Faulty Provider Lists
The CMS plans to more closely monitor Medicare Advantage insurers' provider networks and may fine or otherwise sanction plans that don't accurately show which doctors are available at in-network prices. New provisions related to provider networks and directories were included in the agency's proposed 2016 rate notice, released last Friday. Medicare Advantage payments will drop 0.95% on average, but when accounting for higher risk scores based on coding patterns, health plans on average will receive a 1.05% increase. (Herman, 2/23)
Medicare Drug Guidance Leaves PBMs, Plans Content
Pharmacy benefit management firms and prescription drug plan officials said Monday they are mostly pleased with Friday's decision by Medicare officials to target only those plans that give seniors very limited options of drugstores that offer deeper-than-usual discounts. So-called preferred pharmacy networks have grown in popularity in the past few years. As Medicare prescription drug plans increasingly offer seniors lower copays and cost-sharing if beneficiaries use pharmacies that offer deep discounts, neighborhood pharmacists have complained that they are losing customers. Both sides were watching Friday’s Centers for Medicare and Medicaid Services annual guidance to see if federal officials would require drug plans to allow more pharmacies to be designated as preferred pharmacies or otherwise broaden seniors’ choices. (Adams, 2/24)