2023 Medicare Advantage and Part D Proposal Aims to Advance Health Equity, Reduce Beneficiary Cost Sharing

March 7, 2022

The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Contract Year 2023 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs proposed rule. The rule proposes changes to advance the administration’s efforts to improve consumer protections, reduce disparities, and improve health equity in the MA and Part D programs.

ASCO’s comments address proposed changes affecting health equity, beneficiary protections, and access to coverage, such as:

  • ASCO supports CMS’ proposal to require Medicare Advantage Organizations (MAOs) offering dual-eligible special needs plans (D-SNPs) to establish and maintain enrollee advisory committees to solicit direct input on ways to improve access to covered services, coordination of services, and health equity.
  • ASCO supports CMS’ proposal to require initial and annual health assessments to include standardized questions on enrollees’ social determinants of health.
  • ASCO supports CMS’ proposal to specify that the maximum out of pocket limit in a D-SNP plan is based on all cost-sharing paid by the beneficiary, Medicaid, other secondary insurance, or remains unpaid.
  • ASCO supports the updated definition of “negotiated price” to include performance penalties at the point of sale; however, the Association is concerned about the widespread practice of pharmacy benefit managers applying Star performance ratings and related direct and indirect remuneration claw back fees to oncology dispensing physicians and practice-based pharmacies.
  • ASCO supports CMS’ proposal to require plans that are applying for new or expanded service areas to demonstrate they meet MA network adequacy standards as part of the application process.
  • CMS sought feedback on how MAOs’ prior authorization requirements for patient transfers impact a hospital’s ability to furnish the appropriate care to patients in a timely manner during the public health emergency (PHE). ASCO’s comments highlight that prior authorization has a far greater impact on patients and providers beyond what is occurring in hospitals when transfer to post-acute services is delayed, and the Association urges CMS to assess the impact of MAOs’ prior authorization requirements on physicians’ ability to effectively manage resources and provide appropriate and timely care both during the PHE and beyond.

Read the full comment letter.

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