More On MA Retrenchment
More details on the Medicare Advantage (MA) landscape files and the depth of retrenchment for 2027. In total, the number of MA plans to be offered will only drop from 5,553 in 2026 to 5,532 in 2027. But that hides the impacts of adds and cuts. The number of impacted enrollees looks much bigger than anticipated.
A Modern Healthcare analysis finds that the number of individual MA with Part D prescription drug coverage (MA-PD) products will decline 8% in 2027. Further, it says that there will be 181 counties with no plans next year, up from 67 this year. And at least 3.8 million people will be forced to select new coverage after their insurers terminate a plan. Various analyses peg 2026 impacts at between 2.9 million and 4.6 million. I think the 2027 impact will be closer to 3M — still a shock for me.
While many are adding products in areas, reductions of offerings is big. HCSC has the biggest net reduction at 498, with Centene at 344, United at 140, and Aetna at 123.
Despite major investments over the past few years, Dual Eligible Special Needs Plans (D-SNPs) are being reduced overall, with Chronic Care SNPs (c-SNPs) still increasing.
Additional article: https://www.modernhealthcare.com/insurance/mh-medicare-advantage-plans-2027-cms/
#medicareadvantage #enrollment
https://www.healthcaredive.com/news/medicare-advantage-cuts-2027-cms-landscape/831563/
Elevance To Adopt Site Of Care Oversight
Elevance Health is rolling out site of care payment policies. Under Elevance’s new policies, providers will be required to identify the physical location where a service was offered and information will be checked to ensure that certain services provided at off-campus hospital facilities are reimbursed appropriately. It is a wise step given how certain services are billed.
#siteofcare #elevancehealth #hospitals
https://www.fiercehealthcare.com/payers/elevance-health-rolls-out-new-site-care-billing-policies
Health Affairs Covers Biosimilars, Drug Lawsuits
Health Affairs Forefront Blog had two interesting blogs on drug lawsuits and biosimilar regulation. In the first, the blog covers the losses seen by drug makers on constitutional grounds in fighting the Medicare drug price negotiations. It is now pivoting to attacks on statutory grounds.
In the second blog, several bipartisan bills moving in Congress on biosimilar competition are examined.
Additional article: https://www.healthaffairs.org/content/forefront/more-industry-losses-medicare-drug-prices-litigation
#biosimilars #drugpricing #ira #medicare #partd
— Marc S. Ryan
