CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonst

[kgmom219]

The National average went from $64 to $179.

So now the plans are being asked to participate in a $35 increase cap. Key word: ASKED.

Oh well.

Chaos equals opportunity!

 

[DonP]

It does seem like a Part D panic.

Not sure what they expected carriers to do with rates in repsonse to 3x higher % of RX costs shifted to insurers, but it's almost August and CMS just had an "oh no" moment.

"The IRA is designed to limit yearly premium increases from contract year 2024 to 2029. Because Part D and prescription drug plans can result in plan price variation for beneficiaries, CMS is creating the Part D Premium Stabilization Demonstration to “improve premium stability for participating stand-alone prescription drug plans,” according to a news release.

This should result in a smoother rollout in how the IRA requires Medicare to support Part D prescription plans. The program will test whether even more financial requirements would improve the Part D program, a senior CMS official said Monday afternoon."

That's a healthy word salad. I suppose they don't want $0 premium MAPD plans to have an annoying $2 or a $13 monthly premium based on drugs, so this solves that for a year.

And they don't want angry sticker shock for stand alone plans to result in dropped policies by healthy people, get a smaller, sicker pool enjoying the $2K max, so this delays that. Doesn't solve it.

You would have to be pretty dense not to see this coming, and the line I put in bold above should let you know it isn't done yet.

How does this effect mapd rx part ? It read like this is only for pdp stand alone .

 

[axeman462]

How does this effect mapd rx part ? It read like this is only for pdp stand alone .

looking at the first looks for MAPD, it doesn't look like it has affected them a whole lot. increase in rx deductibles, but thats about it

 

[DonP]

looking at the first looks for MAPD, it doesn't look like it has affected them a whole lot. increase in rx deductibles, but thats about it

What first looks from major carriers have shown benefits yet ?I’ve seen none. The next week several show

 

[Truce]

DonP said:
How does this effect mapd rx part ? It read like this is only for pdp stand alone

It specifically does NOT affect MAPD. Correct

But It looks like the providers can use the PDP rebates and reallocate them for MAPD plans that would otherwise have a tiny premium for some members, and the implication is that tiny premium came from the volatililty on the drug side.

After reviewing the plan-specific information in HPMS, some bids may need to be resubmittedto adjust the MA rebate dollars in the Bid Pricing Tool (BPT). Local MA-only plans (which donot offer Part D) and PDPs (which cannot use MA rebates) cannot resubmit their bids during therebate reallocation period. In the instances when an MA-PD allocates all of its MA rebates tobuy down the Part D basic premium and the plan’s intended target for its Part D basic premiumis the low-income premium subsidy amount, the MA-PD may volunteer to use the de minimispremium policy.

 

[Chazm]

What first looks from major carriers have shown benefits yet ?I’ve seen none. The next week several show

UHC shows all of there plans now and most of the benefits.
The uhc PPO in my area lowered their MOOP from $4900 to $4500. The HMO from 2900 to $2800 (the sky is falling!). They don’t give specialist or hospital copays yet.
They added a deductible on brand drugs.

 

[axeman462]

What first looks from major carriers have shown benefits yet ?I’ve seen none. The next week several show

uhc and wellcare

 

[axeman462]

UHC shows all of there plans now and most of the benefits.
The uhc PPO in my area lowered their MOOP from $4900 to $4500. The HMO from 2900 to $2800 (the sky is falling!). They don’t give specialist or hospital copays yet.
They added a deductible on brand drugs.

you see the villages plan is giving a Part B refund next year? :-)

 

[DonP]

UHC shows all of there plans now and most of the benefits.
The uhc PPO in my area lowered their MOOP from $4900 to $4500. The HMO from 2900 to $2800 (the sky is falling!). They don’t give specialist or hospital copays yet.
They added a deductible on brand drugs.

$4500 ?Lol you’re always boosting of all your $1k mops in your area . How can you sell that with all the $1k’s? United’s stock hit all time high today . They can sell a few million shares and eat the increased costs . We knew united would be near the tops. We got no info on any of the benefits or copay’s .My area the rx looks similar to last yr . $295 tiers 3-5 deductible and 0/12/47/100 copays . Thats very strong .

 

[Yagents]

OOP on mapd for rx is 2k next year also, so it is effected. Ded, copays and formulary will change. $$ to fund it will come from other mapd areas.

[But I may be wrong since I don't sell mapd]