RISE gathers up the latest news that impacts Medicare and Medicare Advantage (MA).

CMS lowers Medicare Part D insulin costs for seniors

More than 1,750 standalone Medicare Part D prescription drug plans and MA plans with prescription drug coverage have applied to offer lower insulin costs through the voluntary Part D Senior Savings Model for the 2021 plan year, according to the Centers for Medicare & Medicaid Services (CMS). Participating plans will offer Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply from the beginning of the year through the Part D coverage gap.

CMS launched the Part D Senior Savings Model in March. It estimates that beneficiaries who use insulin and join a plan that participates in the model may see an average out-of-pocket savings of $446 or 66 percent for their insulins. In addition, CMS expects that beneficiaries will have Part D plan options in all 50 states, the District of Columbia and Puerto Rico, through a standalone prescription drug plan or an MA plan with prescription drug coverage during Medicare open enrollment, Oct. 15-Dec. 7 for Part D coverage that begins Jan. 1, 2021.

One in every three Medicare beneficiaries has diabetes, and more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For some of these beneficiaries, access to insulin is a critical component of their medical management, with gaps in access increasing risk of serious complications ranging from vision loss to kidney failure to foot ulcers to heart attacks. However, the costs of insulin can be a major barrier to appropriate medical management of diabetes.

CMS said it will enhance the Medicare Plan Finder to include a filter to identify plans that will offer capped out-of-pocket costs for insulin in the model so beneficiaries can easily find those plans during open enrollment in the fall. The Medicare Plan Finder, which was upgraded for the first time in a decade last year, is the most used tool on Medicare.gov and allows users to shop and compare Medicare Advantage and Part D plans.

API provisions enforcement delayed

The Centers for Medicare & Medicaid Services (CMS) announced it will not enforce the new requirements for Patient Access Application Programming Interface (API) and Provider Directory API until July 1, 2021 as a result of COVID-19. The policies for MA, Medicaid, and the Children’s Health Insurance Program take effect on Jan. 1, 2021. CMS said it would delay enforcement for six months to provide additional flexibilities to payers.

Study: MA-FFS switching more prevalent among disabled

A new study published in Health Affairs examines the likelihood and characteristics of those who switch between MA and traditional Medicare 12 months before and after the onset of a disability. Researchers used data for 2011-2016 from the National Health and Aging Trends Study linked to Medicare claims to measure and characterize switches.  They found that the rate of switching from MA to traditional Medicare increased slightly after disability onset. However, people with greater levels of disability were more likely to switch. Indeed, 36 percent of those who switched needed help with two more activities of daily living compared to 14.3 percent of those who switched from traditional Medicare to MA. Researchers said the findings show the benefit of including functional measures in MA plan risk adjustment and quality measures. In addition, older adults with disability may experience lower quality of care in MA and will leave before accessing the program’s expanded benefits.