Medicare Opioid users will have 12 -24 month plan lock in for MAPD/PDP

[policywunk]

I have heard it hasn't effected 2/1/19 effective date enrollments but it probably will for a 3/1/19 effective. With about 31 % ( even higher for under 65 ) of medicare beneficiaries taking opioids this will impact enrollment opportunities I am sure but on the positive side it will help with persistency especially for dual/ under 65 book of business.


https://www.cms.gov/Outreach-and-Ed...-MLN/MLNMattersArticles/Downloads/SE18016.pdf

 

[TwoCents]

Well, the lock-in to be able to change plans only applies to those wanting to use the LIS/Dual Eligible election which already has a quarterly limitation (Q1-3; not available in Q4). Even then, those people could still change plans if they happen to have another available election.

 

[policywunk]

Well, the lock-in to be able to change plans only applies to those wanting to use the LIS/Dual Eligible election which already has a quarterly limitation (Q1-3; not available in Q4). Even then, those people could still change plans if they happen to have another available election.

My understanding is that any medicare beneficiary with opioid /pain management profile will be locked in for at least 12 months and possibly as long as 24 months.The only reason it hasn't effected 2/1 enrollments is because the lock in is being based on 2019 usage data which the carriers don't have of enough yet for 2019 to make the determinations but supposedly they will in February.

 

[TwoCents]

My understanding is that any medicare beneficiary with opioid /pain management profile will be locked in for at least 12 months and possibly as long as 24 months.The only reason it hasn't effected 2/1 enrollments is because the lock in is being based on 2019 usage data which the carriers don't have of enough yet for 2019 to make the determinations but supposedly they will in February.

Medicare Managed Care Eligibility and Enrollment - Centers for Medicare & Medicaid Services

See the 2019 MA Enrollment and Disenrollment Guidance. Starting on pg 43 "SEP for Dual-eligible Individuals and Other LIS-Eligible Individuals." What you posted was provider-centric and talks about lock-in for using certain prescribers and pharmacies. It says nothing about changing plans.