Federal officials gave negative assessments to more than 25 percent of Medicare’s rated prescription drug plans that will be available to seniors in 2012. The Centers for Medicare and Medicaid Services (CMS) is putting these plans on notice that, unless they take steps to improve their performance over the next few years, they face expulsion from Medicare.
CMS this month revised the way it rates Medicare drug plans to focus more on quality, and many plans’ ratings fell from 2011 to 2012. The criteria changed to stress clinical outcomes, such as whether a patient takes his medication the way he is supposed to, in addition to process measures, such as how long a patient is kept on hold when calling the plan. In judging 2012 plans, CMS for the first time considered whether patients kept up with medications for diabetes, hypertension, and cholesterol, and it also considered complaints lodged against plans, and the numbers of people who choose to leave plans.
While the new system labeled more plans as poor performers, CMS says this will likely lead to better options for the 28 million elderly and disabled beneficiaries who rely on those plans to help pay for their medications.
Traditional Medicare does not cover most prescription drug costs for beneficiaries, but they can voluntarily buy
private Medicare Part D drug plans. CMS rates the prescription plans according to a star system, with five stars indicating the highest quality and one star the lowest. That system is similar to ratings for the private Medicare Advantage health plans that about a quarter of seniors choose instead of traditional Medicare.
Earlier this month, CMS proposed a new rule
that would allow it to oust plans that score below three stars for three consecutive years.
The rule would take effect in 2013, and would also allow CMS to terminate low-performing Medicare Advantage health plans on the same timetable.
Nationally, of the 557 rated drug plans that will be available for next year, 24 percent get the top ratings of four or five stars, and about half fall in the middle with three stars. Another 28 percent score below three stars; only one comes in below two.
Source: Kaiser Health News
, October 26, 2011