CMS Releases Medicare Advantage Final Rule

CMS; Medicare
​​CMS released the Contract Year 2022 Medicare Advantage and Part D (MAPD) Final Rule (CMS-4190-F2). The rule codifies several long-standing program changes introduced through previous Call Letters, memos, and other communications. It also introduces a number of new changes. Both types of revisions are summarized below. A more detailed analysis outlining implications for members will be provided in the coming days. 

New provisions:
  1. Beneficiary Real Time Benefit Tool (RTBT) – Part D plans will be required to offer an online tool that will provide beneficiaries with real-time access to prescription drug costs and the ability to compare cost sharing between similar types of drugs.  
  2. New “Preferred” Specialty Tier in Part D – Plans will be allowed to have a second preferred specialty tier with lower cost sharing. 
  3. Pharmacy Performance Measures Reporting Requirements – Due to pharmacy concerns that Part D plan performance measures are unattainable and impact pharmacy reimbursement Part D, plans will now need to disclose their pharmacy performance measures to CMS. 
  4. Implementation of Opioid Provisions – Provisions outlined in the Substance Use-Disorder Prevent that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. These provisions impact Part D plans primarily, but also includes requirements for MAPD plans related to reporting the inappropriate prescribing of opioids. 
Changes to Existing Provisions:
  1. Supplemental Benefit Requirements outlined in Chapter 4 of the Medicare Managed Care Manual. 
  2. ​Routine updates to MA and Part D Program Quality Rating System including measures and technical clarifications.