Humana, UnitedHealthcare, and Some Blues Selected for New Part D Experimental Model

Six organizations that operate Medicare Part D plans have been chosen to participate in CMS’ new enhanced medication therapy management model, which officials hope will better monitor medication use and therefore cut down on hospital and emergency department visits. The six sponsors are: Humana, UnitedHealthcare, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Plains Alliance, CVS Health, and WellCare Prescription Insurance. They operate a total of 22 benefit packages covering about 1.6 million beneficiaries.

The program is set to begin in January. Participants will be given financial incentives to make innovative changes to Part D plans. CMS believes that such experimentation is needed because presently Part D plans fall short in providing cost-effective care. “Currently, Part D statutory and regulatory MTM provisions require uniform service offerings to enrollees who meet the plan’s program criteria, based on numbers of medications and chronic conditions and expected annual prescription drug costs,” CMS said in a statement. “The result is that Part D MTM programs may not include the level or resources nor the type of activities that could have the greatest positive effect on beneficiary outcomes.” 

Source: CMS