The Medicare Payment Advisory Commission (MedPAC) has voted to recommend in its June report to Congress that lawmakers try to reduce confusion about how and whether certain medications are covered by Medicare’s Part D or Part B.
One MedPAC suggestion calls for directing Part D plans to cover certain drugs all the time, regardless of whether the drugs also could be eligible for reimbursement under Part B. This doesn’t eliminate the problem of so-called overlap drugs, but it might ease access problems for beneficiaries and administrative burdens faced by providers.
MedPAC also is considering ways of addressing concerns about Part D drug coverage for long-term care beneficiaries. Among the options: Keeping the Part D program as it is, with the addition of quality data reporting; setting up LTC pharmacies as the main Part D provider for the facility they serve; or allowing the Centers for Medicare & Medicaid Services to hold periodic competitions for plans to select a single prescription drug plan for all residents in a geographic area.
MedPAC also will recommend that Congress repeal the existing wage index statute, to help minimize differences between adjacent counties. The panel recommends establishing a new wage index system that uses wage data from all employers and industry-specific occupational mixes to adjust for geographical differences in employee benefits. MedPAC also recommends that CMS use the new wage index for skilled nursing facility and home health prospective payment systems to evaluate its use with other areas where the prospective payment system is applied.
