Medicare 2019 to See Increase in Pay and Opioid Oversight

Medicare Advantage Part D rising costs

Medicare Advantage to see payment increase in 2019

On Thursday, the U.S. government proposed a 1.84% payment increase for those enrolled in Medicare Advantage for fiscal year 2019. January data indicates that Medicare Advantage 2018 enrollment was 20.9 million elderly and disabled individuals and accounts for 35% of all Medicare enrollment. This hike in price also comes with changes in coverage, including wheelchair ramps and other necessary assistive devices. Rate increases will be determined based on factors like geography, health of members, and the quality rating of the insurer.

Medicare tackles the opioid epidemic with increased oversight

Under the same proposal, Medicare is adjusting the way it handles opioid prescriptions in the wake of the national opioid abuse epidemic. In addition to consulting with their doctor, patients would also need to get approval from their drug plan if a new morphine-like painkiller prescription puts them above the recommended cumulative dosage. Medicare will also limit initial opioid prescriptions, for example, to a 7-day supply following surgery or an injury.

The Centers for Medicare and Medicaid Services (CMS) is enhancing their opioid monitoring system by adding a flagging feature for certain drugs used in combination with prescription opioids. CMS has already experienced some success in reducing opioid abuse in the Part D program and intends to increase oversight by limiting the number of prescribers and pharmacies Part D beneficiaries can use to receive prescription opioids.

Why the changes?

According to CMS, the purpose of these proposed changes is intended to increase flexibility of Medicare Advantage to allow more options, provide new benefits to Medicare beneficiaries, and ensure appropriate patient-doctor-plan communication to combat the opioid crisis. “Our priority is to ensure that our seniors have more choices and lower premiums in the Medicare health and drug plans,” said CMS Administrator Seema Verma. “This is a big win for patients.”

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