2024 Medicare Spring Forum
The 2024 Medicare Spring Forum brought together health plan clients and PBM leaders to discuss the critical forces impacting Medicare and how CVS Caremark can support them. Clients had an opportunity to network with both presenters and CVS Caremark leaders as well as those from the broader enterprise.
Medicare legislative landscape
Federal and state regulatory considerations for Medicare plans
Kimberly Draper, VP, Regulatory Affairs
Sergio Santiviago, Lead Director, Government Relations
Key takeaways:
There is growing bipartisan skepticism around PBM practices, utilization management (UM) tools, and the role that plan sponsors, health insurance issuers, and PBMs play in the drug supply chain.
The current federal legislative session has seen the most scrutiny on health plan prescription drug benefits and PBM practices in years, and new legislation pushed by industry opponents has not been passed. Pending election season, we will likely see reduced momentum for anti-PBM regulations and new limitations until January 2025.
Industry opponents are expected to vigorously resume their efforts to limit plan sponsors’ ability to determine their own drug coverage designs, including access to drugs at lowest net cost.
Preparing for 2025
IRA and actuarial landscape and insight
Kevin Pierce, FSA, MAAA, Senior Consulting Actuary, Milliman
Michelle Klein, FSA, MAAA, Senior Consulting Actuary, Milliman
Becky Justice, FSA, MAAA, Executive Director, Actuarial Services
Key takeaways:
Plans should consider the impact of manufacturer phase-in and risk adjustment changes for 2025 bids.
- They should be aware of how members progress toward their $2,000 maximum out-of-pocket (MOOP) and incorporate new CMS guidance.
- Plans also should consider and include impacts of bad debt and administrative expenses from Medicare Prescription Payment Plan (M3P) in 2025 bids.
Operational readiness
Bruce Feodoroff, VP, PBM Government Services
Yvonne Southwell, VP, Medical Affairs
Sara Nelson, Lead Director, Regulatory Affairs
Rebekah Ocker, RN, CCA, Senior Manager, Government Programs Strategic Insights & Communications
Key takeaways:
Health plan clients have access to a full-service solution meeting all requirements for Medicare Prescription Payment Plan (M3P).
- IRA changes to existing Part D benefit design necessitate formulary and UM options with narrower coverage for flexibility in supporting redesign impacts.
- Beginning January 1, 2025, CMS will include “oral-only drugs” as part of the End-Stage Renal Disease (ESRD) bundle; if Kidney PATIENT Act passes, the bill would delay implementation until 2033.
- Wegovy for cardiovascular disease (CVD) risk reduction is a covered indication for Medicare Part D and will be appropriately managed by confirming alignment to the labeled indication.
CVS Caremark is working diligently to implement operational changes related to 2025 Medicare Part D redesign. The volume of changes and releases require continued partnership through Welcome Season.
We have tools available to monitor the Inflation Reduction Act regulatory changes, view member analytics and monitor effectiveness of plan design changes.
Stars insights and capabilities to enhance quality performance
Moderator:
Shelley Clermont, Executive Director, Government Programs Quality Performance
Panelists:
Anna George, Senior Manager, Population Health, Oak Street Health
Jack Shamshoian, Executive Director, Product Management
Meghan Sinclair, VP, Product, Signify Health
Neeraj Thakur, Pharm. D., Executive Director, Retail Health Product & Services
Matt Wilson, VP, Care Solutions
Key takeaways:
Our enhanced targeting model will incorporate current and historical member data and unique member experience information to create a personalized and evolving view of the member.
The connection of care delivery assets will allow us to influence and close member gaps in care; this will lead to improved outcomes for both plans and members.
Insight and solutions to support client needs and goals
Understanding and addressing barriers to medication adherence
Kim Craig, Senior Manager, Government Programs Strategic Insights & Communications
Key takeaways:
There is value in communication to ensure members are using available resources and understand benefit of taking medications as prescribed. Our research identified eight key barriers to medication adherence. Demographic, attitudinal, and behavioral differences among non-adherent members can be used to inform plan response.
We have an opportunity to address adherence for multiple Stars conditions simultaneously. Targeted messaging, education, and care coordination can help to inspire change for the most vulnerable members.
Investing in mail order to elevate member experience
April Stare, Director, Quality Program Management
Osmayda Nasco, Executive Director, Mail Order Pharmacy Operations
Vicki O’Connor, Senior Manager, Government Programs Strategic Insights & Communications
Key takeaways:
The promotion of mail order pharmacy and education of members is key to increasing adoption and satisfaction. Our partners across the enterprise are collaborating to elevate the member experience through mail order. Through data reviews, key themes were identified to enhance communications for best-in-class mail order member experience.
For more information or copies of the presentations, please contact your account team. A downloadable version of this summary is available here.
