Part D Advisors Industry Newsletter

June 2020 ▼

COVID-19 and Return to Work

Plan sponsors should take note that the COVID-19 pandemic has created an interesting situation in regards to member’s eligibility if they choose to return to work for financial or health benefit related purposes. If a member returns to work, it is the Plan Sponsor’s duty to provide the updated eligibility to CMS/RDS in a timely manner. Retirees may be eligible for subsidy, but then return to active status and lose that eligibility, multiple times per year and, as such, CMS/RDS allows Plan Sponsors to update eligibility as often as needed…continue reading

May 2020 ▼

Important Enhancement to RDS Payment Frequency

CMS’ RDS Center is pleased to announce that beginning May 8, 2020, all RDS applications’ Payment Frequency will be set to a maximum frequency of monthly interim payments, consistent with the general payment rules regarding timing set forth in 42 C.F.R. 423.888(b)(1). This enhancement will be applied to all current and active RDS applications, as well as all future RDS applications. Plan Sponsors who had previously selected the Quarterly or Annual Payment Frequency option on their current applications will now be eligible to submit interim costs and request interim payments more frequently than quarterly or annually, if so desired. No action is required on the part of the Plan Sponsor or its Vendors to implement this new feature…continue reading

April 2020 ▼

COVID-19: An Update for Our Valued Partners & Customers

Michigan Governor Gretchen Whitmer issued Executive Order 2020-42, which requires all business in the state of Michigan to temporarily suspend in person operations until at least May 1st, 2020 in order to suppress the spread of novel Coronavirus. Please rest assured that Part D Advisors will remain in operation during this national crisis. PDA staff have been thoroughly trained and our equipment is prepared to operate remotely so that our clients and partners will not see any disruption in their service…continue reading

March 2020 ▼

Working Past 65: How to Handle Medicare Enrollment

If you’re counting on working past your 65th birthday, be sure to consider how Medicare may factor into your plans — even if you already have health insurance through your job. The share of people ages 65 to 74 in the workforce has been steadily rising for years. It’s projected to reach 30.2% in 2026, up from 26.8% in 2016 and 17.5% in 1996, according to the Bureau of Labor Statistics…continue reading

February 2020 ▼

Your Group Health Plan May Have One Lingering CCN Requirement – and the Deadline is Looming

As most Group Health Plans are likely already aware, they are required to notify the CMS every year as to whether their drug coverage is “creditable” or “non-creditable” for Medicare Part D purposes. This notice must be mailed to all Medicare Eligible plan participants annually before Oct 15. However, in addition to the mailing, the CMS requires a separate online disclosure notification for the Plan…continue reading

January 2020 ▼

The Important Medicare Move You Should Make Sooner Rather Than Later

Even though Medicare Open Enrollment ended in December, the Medicare Advantage Open Enrollment Period is going on right now. This is an opportunity for those who are currently enrolled in Medicare Advantage to change plans….continue reading

December 2019 ▼

Medicare Data Breach Impacts Nearly 220,000 Beneficiaries

The Centers for Medicare and Medicaid Services (CMS) announced that about 220,000 Medicare beneficiaries’ card numbers have been compromised by an unknown person or organization. It is unknown how this data breach occurred, but CMS is taking steps to remedy the situation and prevent its re-occurrence in the future…continue reading

November 2019 ▼

Trump Administration Delays Rule Forcing Hospital-Cost Transparency

The Trump administration is delaying a rule that would require hospitals to share negotiated rates because officials said they are working to expand the plan to include insurers.The Centers for Medicare and Medicaid Services had proposed making hospitals next year share the rates they negotiate with insurers, with a possible fine of up to $300 a day for failing to comply. The mandate would have covered all the more than 6,000 hospitals that accept Medicare, as well as some others…continue reading

October 2019 ▼

Medicare Advantage and Part D Premiums Set to Drop in 2020

Ahead of Medicare Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) announced today that, on average, Medicare Advantage premiums in 2020 are expected to decline 23 percent from 2018 while plan choices, benefits and enrollment continue to increase…continue reading

September 2019 ▼

Medicare’s Plan Finder Gets an Upgrade

For the first time in a decade, the Centers for Medicare & Medicaid Services (CMS) recently launched a modernized and redesigned Medicare Plan Finder, allowing users to shop and compare Medicare Advantage and Part D plans. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer. …continue reading

August 2019 ▼

HHS Announces New Plan for Safe Importation of Prescription Drugs

The U.S. Department of Health and Human Services (HHS) recently announced that HHS and the U.S. Food and Drug Administration (FDA) are publishing a Safe Importation Action Plan that outlines two potential pathways that would lay the foundation for the safe importation of certain drugs originally intended for foreign markets…continue reading

July 2019 ▼

What the Alexander-Murray Bill Could Mean for PBMs

In late May, Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) unveiled a plan that they say will lower healthcare costs and remove surprise bills. One major part of that plan could radically change PBMs in the future. The proposed bill, S 1895, moved through the Senate Health Committee with a vote of 20 to 3 and could hit the senate floor by the end of July…continue reading

May 2019 ▼

Part D Advisors Acquires Eligibility Verification Business

Part D Advisors, Inc. (PDA), the nation’s largest administrator of Medicare’s Retiree Drug Subsidies (RDS), announced the purchase of select assets from Health Decisions, Inc. (HDI) in Plymouth, Michigan. The assets are related to Health Decisions’ Dependent Eligibility Audit and other eligibility verification services…continue reading

March 2019 ▼

RDS Cracking Down on Security Violations

The Centers for Medicare & Medicaid Services’ (CMS) Retiree Drug Subsidy (RDS) Center has begun cracking down on users that are caught sharing or transferring user accounts or logins and passwords, which is a violation of Federal Law. If CMS’ RDS Center detects suspicious activity with a user account, the account will be deactivated until the issue is resolved…continue reading

February 2019 ▼

2019 Medicare Advantage and Part D Prescription Drug Program Landscape

The CMS’ Center for Medicare and Medicaid Innovation (CMMI) announced a new model to try to shrink skyrocketing Medicare Part D drug spending. It also expanded the scope of its value-based insurance design (VBID) model for Medicare Advantage plans. …continue reading

January 2019 ▼

Government Shutdown: What Does It Mean for American Healthcare?

There seems to be no end in sight for the current partial government shutdown, but for the vast majority of the federal government’s public health efforts, it’s business as usual. Congress has already passed five of its major appropriation bills, including funding for the Department of Health and Human Services (HHS) through September 2019. As a result, flagship government health programs such as the Affordable Care Act, Medicare and Medicaid remain insulated…continue reading

December 2018 ▼

RDS Secure Website Updates Coming in 2019

The Retiree Drug Subsidy (RDS) recently held a Website Modernization webinar about upcoming program changes that will affect all RDS Plan Sponsors and all users of the RDS Secure Website. The session provided an overview of the RDS Secure Website Modernization project and highlighted some important changes that will be coming in 2019…continue reading

November 2018 ▼

Blue House, Red Senate: Midterm Election Results and the Future of American Healthcare

The 2018 midterm elections panned out as predicted: Republicans kept the Senate majority and Democrats now have control of the House. With these results, the partisan divide in Congress continues to widen. According to several recent polls, healthcare was the #1 issue for voters heading into the election, with Rx prices, single-payer coverage and Medicare and Medicaid funding topping the list of concerns…continue reading

October 2018 ▼

2019 Medicare Advantage and Part D Prescription Drug Program Landscape

Both the Medicare Advantage and the Part D prescription drug programs continue to grow and provide high quality care and services to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums will decline in 2019 while plan choices and new benefits will increase…continue reading

September 2018 ▼

PDA is the Nation’s Only SOC Certified RDS Administration Firm

After months of hard work and dedication, Part D Advisors is proud to announce that we have successfully completed our annual SOC 1, Type 2 audit. The culmination of this audit of PDA’s systems and controls means we are the nation’s only AICPA SOC certified Retiree Drug Subsidy (RDS) administration firm…continue reading

August 2018 ▼

CMS Empowers Patients with More Choices

The Centers for Medicare & Medicaid Services (CMS) is delivering on President Trump’s promise to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions. This action is an important step towards providing patients with more choices when picking a Medicare Advantage plan that best meets their needs….continue reading

July 2018 ▼

Amazon Enters the Pharmacy Business with PillPack Purchase

Amazon has agreed to buy the small online pharmacy PillPack in a deal that will further the retail giant’s ambitions in healthcare. The deal is expected to close in the second half of 2018, helping set up a showdown between Amazon and pharmacy benefit managers…continue reading

June 2018 ▼

CMS Delivers Message to Plans: Stop Hiding Information from Patients

The Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that gag clauses that keep patients from knowing how to get the best deal are unacceptable…continue reading

May 2018 ▼

CMS Pushes Hospitals to Post Prices Online

The Centers for Medicare & Medicaid Services (CMS) announced that it may require that hospitals post charge information as part of the proposed 2019 Inpatient Prospective Payment System rule…continue reading

April 2018 ▼

What You Need to Know About Your New Medicare Card

To better protect the 60 million people enrolled in Medicare from identity theft, the government has begun the process of sending out new, more secure Medicare cards. Click here to learn more about when to expect your new Medicare card, what to do with your old Medicare card, as well as how to protect yourself from potential scams…continue reading

March 2018 ▼

Rollout of New Medicare Cards Begins in April

The Centers for Medicare & Medicaid Services (CMS) is required to remove social security numbers from all Medicare cards by April 2019. Starting next month, CMS will begin mailing the new Medicare cards in phases based on geographic location and other factors. Click here to learn when new Medicare cards will be rolled out in your area….continue reading

February 2018 ▼

CMS Announces New Payment Plan Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality…continue reading

January 2018 ▼

Medical Expense Deduction Stays Alive in GOP Tax Bill

The deduction that allows people with very high medical costs to shrink their taxable income by subtracting some out-of-pocket medical expenses was a hot topic during the congressional debates this fall. But with the recent passing of the new tax bill, the deduction will continue to be preserved and even expanded upon…continue reading

December 2017 ▼

Fiduciary Rule Officially Delayed Until 2019

The Department of Labor (DOL) has officially delayed full implementation of the fiduciary rule by 18 months, with the expected implementation of the rule’s Best Interest Contract Exemption now pushed back until July 1, 2019…continue reading

November 2017 ▼

CMS Finalizes Two Medicare Payment Rules

The Centers for Medicare & Medicaid Services (CMS) finalized two Medicare payment rules that move the agency in a new direction by putting patients first and ensuring that payments support access to high-quality, affordable care. The Hospital Outpatient payment rule will also help lower out-of-pocket drug costs for people with Medicare…continue reading

October 2017 ▼

CMS Reveals New Medicare Card Design

The Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number…continue reading

September 2017 ▼

CMS Issues Projected Drug Premiums for 2018

The Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to decline to $33.50 per month…continue reading

August 2017 ▼

Federal Advisory Committee Calls for HHS to Rescind Plan Identifier Rule

A federal advisory committee called on the U.S. Department of Health and Human Services (HHS) to rescind a 2012 rule that established a standard unique identifier for health plans…continue reading

July 2017 ▼

CMS’ Proposed Quality Payment Program Updates

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring…continue reading

June 2017 ▼

New Medicare Cards offer Greater Protection to more than 57 Million Americans

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card…continue reading

May 2017 ▼

News Flash – CMS Social Security Number Removal Initiative

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that the Centers for Medicare & Medicaid Services (CMS) remove Social Security Numbers (SSNs) from all Medicare cards by April 2019…continue reading

April 2017 ▼

Beware of High-Pressure, Misleading Marketing Campaign

It has come to our attention that many plan sponsors participating in the Retiree Drug Subsidy (RDS) program may have recently received information from another firm regarding the RDS reopening appeals process. The information being mailed is misleading, inaccurate, and potentially dangerous for RDS plan sponsors…continue reading)

March 2017 ▼

Congressional Budget Office Estimates of New Healthcare Act

On March 13, 2017, the Congressional Budget Office (CBO) released their report estimating the budgetary effects of President Trump’s proposed alternative to the Affordable Care Act – the American Health Care Act. Here are some of the COB’s estimates…(continue reading)

February 2017 ▼

What’s Happening to the ACA?

One month into President Trump’s administration, many questions are being posed about the future of the ACA. While there is no definitive plan in place yet to either repeal, replace or reform the ACA, Republicans have proposed a number of alternative options…(continue reading)

January 2017 ▼

Four Tips for Employers before Trump’s Swearing In

Throughout his campaign, Donald Trump vowed to quickly repeal and replace the Affordable Care Act, marking it as a high priority for his first 100 days in office. In his health care reform letter, he wrote “On day one of the Trump administration…(continue reading)