Radar on Medicare Advantage
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States Spent Less on Medicaid During the Pandemic — but Enhanced Funding Is Winding Down
States received more than $117 billion in enhanced federal funding during the COVID-19 pandemic’s Medicaid disenrollment pause, according to a new KFF analysis. With unemployment on the rise during the pandemic, Medicaid rolls surged, but state spending did not. States spent $231 billion on Medicaid in 2019; that figure dropped to $214 billion in 2020, KFF reported. Since then, state spending has yet to surpass 2019 levels. That’s because the federal government elected to increase the Federal Medical Assistance Percentage (FMAP) 6.2 percentage points in exchange for states’ suspension of eligibility redeterminations for the duration of the Public Health Emergency (PHE). But instead of ending the enhanced FMAP funds with the expiration of the PHE, the Consolidated Appropriations Act of 2023 allowed for enhanced funding to begin a gradual decrease — to 5 percentage points higher than normal levels in April, 2.5 in June, and 1.5 in October.
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MedPAC Floats Benchmarking Options to Address Favorable Selection in MA
Favorable selection associated with beneficiaries choosing Medicare Advantage — which now enrolls more than half of Medicare beneficiaries — in combination with more intense diagnostic coding by plans is leading to increased MA payments that may not accurately reflect the costs of providing care to those beneficiaries, asserts the Medicare Payment Advisory Commission (MedPAC) in its latest report to Congress. And the independent advisory body has some new takes on potential payment policies that aim to lessen the impact of favorable section by moving away from predictive-cost benchmarking that is based solely on fee-for-service (FFS) Medicare spending.
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News Briefs: CMS Plans to Post List of Alzheimer’s Drug Registries for Physician Choosing
As the FDA prepares to make a full approval determination on Alzheimer’s drugs such as Biogen Inc.’s Leqembi (lecanemab-irmb), CMS has released new details about its plan to collect real-world data on Medicare patients taking the drugs. To qualify for Medicare coverage of a drug with traditional FDA approval that may slow the progression of Alzheimer’s disease, patients’ physicians will have to participate in the collection of evidence about how the drugs work in patients through a registry. And they will be able to submit that information in an “easy-to-use format” through a nationwide, CMS-facilitated portal, the agency explained last month. CMS is working with multiple organizations preparing to launch their own registries, and once available, those will be listed online and clinicians may choose a registry for participation, the agency clarified on June 22. CMS also listed the various elements it intends to capture through the registry, including information related to questions in the National Coverage Determination, such as whether the drug meaningfully improves health outcomes (i.e., slows the decline of cognition and function) for patients in broad community practice, and whether the benefits and harms (e.g., brain hemorrhage and edema) associated with the use of the drug depend on the characteristics of patients, treating clinicians and setting. The FDA decision is expected by July 6.
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Citing Concerns About Broader MA Trends, NYC Comptroller Puts Aetna Pact in Peril
For the second time in recent history, New York City Comptroller Brad Lander is refusing to register the city’s contract with a Medicare Advantage insurer. But this time it’s not just legal challenges that has the comptroller questioning the city’s move away from fee-for-service (FFS) Medicare, but the broader trends in the MA industry. And CVS Health Corp.’s Aetna is ready to defend its positioning as an experienced provider of retiree health benefits.
After multiple delays, the city was planning to transition some 250,000 retirees and their eligible dependents away from FFS Medicare coverage on Sept. 1 to a PPO plan administered by Aetna. The contract is valued at $15 billion over the first five-plus years of the agreement.
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CMS’s Registry Proposal Raises Questions Over Uptake, Cost Burden of Alzheimer’s Drugs
After gaining accelerated approval from the FDA in January, Biogen Inc.’s Alzheimer’s treatment Leqembi (lecanemab-irmb) could receive full approval by July, thanks to a recent 6-0 advisory panel vote. And if the drug — which is subject to limited Medicare coverage per a national coverage determination (NCD) — does receive traditional approval, CMS recently vowed to “ensure availability” of new drugs that may slow the progression of Alzheimer’s disease if qualifying Medicare patients are monitored through a registry.
Leqembi would be the first drug to be covered under this type of arrangement, which has historically been reserved for new medical and diagnostic devices. But sources say uncertainty about both the registry and coverage of imaging associated with the drug makes it hard to predict uptake under the supposedly broader Medicare coverage and future costs to Medicare Advantage insurers.
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