News Briefs: New MA and Part D Rule Is Pending at OMB | Nov. 18, 2021

  • The Biden administration’s first Medicare Advantage and Part D regulation is pending review at the Office of Management and Budget. The CMS final rule, titled “Policy and Technical Changes to the Medicare Advantage Program and Medicare Prescription Drug Benefit Program; MOOP and Cost Sharing Limits (CMS-4190),” was received on Nov. 10. It is not economically significant, according to the posting at RegInfo.gov.

    Continuing its push against Medicare Advantage “cuts” in pending budget reconciliation legislation, AHIP on Nov. 8 warned that increasing the MA coding intensity factor could lead to higher premiums. Referring to an updated Avalere Health study, AHIP reported that adjustments to coding intensity could raise MA premiums by between $9 and $25 per month, or an increase of 43% to 115%. That report also included a map showing state-by-state reductions in the availability of $0 premium plans, AHIP said. Citing an analysis performed by Wakely Consulting Group, AHIP in August cautioned that adding dental, vision and hearing benefits without adjusting the MA benchmark payment to MA plans would result in rebate reductions of 48% to 73% on average. The latest version of the $1.75 trillion Build Back Better Act (H.R. 5376), which the House is planning to vote on this week, includes only the addition of hearing benefits in 2023. The Congressional Budget Office is expected to release its full cost estimate on the bill by Nov. 19.

    Medicare Part B premiums will jump by $21.60 next year, driven in part by Biogen Inc.’s costly Alzheimer’s treatment, Aduhelm (aducanumab-avwa), which was approved on June 7. In a fact sheet on Parts A & B premiums and deductibles for 2022, CMS said the standard monthly premium for Part B enrollees will rise from $148.50 in 2021 to $170.10 for 2022, while the annual deductible for all Part B beneficiaries will increase from $203 this year to $233. The agency explained that those increases are due to several factors, including “contingency reserves due to the uncertainty regarding the potential use” of Aduhelm. CMS has yet to complete its National Coverage Determination process to decide whether and how it will cover Aduhelm and similar drugs approved to treat Alzheimer’s disease.

    Zing Health closed its previously announced purchase of Lasso Healthcare Insurance Co., which offers Medicare Medical Savings Accounts in 34 states and Washington, D.C. Zing Health, a Chicago-based provider of Medicare Advantage plans, and Lasso Healthcare will operate separately, while the acquisition will provide Zing with a national footprint to reach diverse communities, the insurer said on Nov. 9.

    Anthem, Inc. has entered into an agreement to acquire Integra Managed Care, a managed long-term care plan in New York that helps adults with long-term care needs and disabilities live at home. Integra currently serves 40,000 Medicaid members through a dedicated care management team that includes a registered nurse, social worker and coordinator, according to Anthem. The company said the acquisition aligns with Anthem’s goal of growing its Medicaid business in a comprehensive and coordinated way. Financial terms of the deal were not disclosed. The acquisition is expected to close by the end of the second quarter of 2022, when Integra will join Anthem’s Government Business Division.

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  • Lauren Flynn Kelly

    Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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