Biden Taking Steps to Lower Prescription Costs and Protect Seniors from Healthcare Scams

The Biden-Harris administration announced proposals to protect the over 30 million on Medicare Advantage from predatory marketing, increase access to behavioral health care, promote equity in coverage, and improve supplemental benefits.

These proposed rules are meant to make the program work to best meet the needs of beneficiaries.

“So I’m pleased that today the Department of Health and Human Services is proposing new Medicare Part C and D rules that will give seniors access to more affordable high quality health insurance and lower prescription drug costs for seniors by increasing competition,” White House Director of the National Economic Council Lael Brainard said on a call with reporters in which PoliticusUSA participated. “Today’s rules are going to save seniors on Medicare Part D money by getting them faster access to lower cost competitors to brand name drugs and we’re going to stop dominant Medicare Advantage plans from taking advantage of seniors.”

Proposals for enhancements to Medicare Advantage and Medicare Part D:

–New Guardrails for Plan Compensation to Agents and Brokers to Stop Anti-competitive Steering

This is meant to address the marketing incentives that can sometimes be used by agents and brokers to mislead seniors into signing up for plans that pay more to the broker but don’t perform as well for the individual or are not in their best interest.

While there have been limits in the past regarding what brokers can be compensated, there were activities outside of that scope so they are broadening the definition and including those items under the proposed $632.00 commission cap. Every plan will play the same amount, so there will not be an additional perk to steer people into a certain plan.

“Currently some large Medicare Advantage insurance companies are wooing brokers and agents with lavish perks like cash bonuses, and golf trips, to incentivize them to steer seniors to those large plans,” Brainard explained.

CMS (Centers for Medicare and Medicaid Services) is proposing to redefine ‘compensation’ to set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in, addressing loopholes that result in commissions above this amount that create anti-competition, according to a fact sheet from the White House.

If this rule is finalized it will make sure seniors get the best plan for their needs rather than the best plan for broker perks, and also make sure that supplemental benefits like hearing and dental insurance are actually accessible to consumers.

The proposed rule will help “close loopholes that allow Medicare managed care plans to inappropriately inflate agents and brokers commissions by adding junk fees,” Department of Health and Human Services (HHS) Secretary Xavier Becerra said.

– Improving Access to Behavioral Health Care Providers

This rule will add a range of behavioral health providers who can enroll in Medicare, including marriage and family therapists and mental health counselors, starting on January 1 of 2024.

The proposed rule will also improve access to behavioral health care by adding a new facility type that includes several behavioral health provider types to Medicare Advantage network adequacy requirements, according to a fact sheet from the White House.

Lowering drug costs:

The proposed rule would improve transparency on the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly substitute lower cost biosimilar biological products for their reference products.

White House Domestic Policy Advisor Neera Tanden pointed out that President Biden is prioritizing lowering drug costs because nearly 3 in 10 Americans haven’t taken their medication as prescribed because they can’t afford it. She added, “This new proposal from CMS answers the President’s directive and that’s why it’s really critical that would provide more flexibility for Part D plans to move quickly substitute biosimilars so that Medicare enrollees have access to lower cost options more quickly.”

Promote health equity:

The administration is proposing to require that Medicare Advantage plans include an expert in health equity and that they conduct an annual analysis “of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors—eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability—compared to enrollees without these risk factors. These analyses would have to be posted publicly to improve transparency into the effects of prior authorization on underserved populations.”

CMS has already prohibited misleading advertising that leads people into thinking the healthcare being offered from the government in the 2024 plan year and “are prospectively reviewing all TV and radio ads,” according to Administrator for the CMS Chiquita Brooks-LaSure.

The cries of disapproval will come from the usual suspects of drug companies, insurance companies and this time around, brokers and agents. But the White House is doing what it can to foster competition to bring prices down for people while also protecting them, which is what the government is supposed to be doing.

And given the absolutely horrific state of healthcare in the U.S. (which is still way better than it was before Obamacare), every bit they can do to make it work better for the people is welcomed.

The proposed rule is here. There will be a 60-day comment period.