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CMS Announces New Part D Payment Modernization Model

Also announces updates to Medicare Advantage value-based insurance design model

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The Centers for Medicare & Medicaid Services (CMS) has announced a new Part D Payment Modernization model, available through the Center for Medicare and Medicaid Innovation, for Part D and Medicare Advantage (MA) drug plans beginning in January 2020.

The voluntary five-year model will test the impact of a Part D payment structure that creates new incentives for plans, patients and providers to choose drugs with a lower list price. The model is open to eligible, standalone prescription drug plans and Medicare Advantage prescription drug plans; CMS will release a request for applications to join the model for calendar year 2020 in the near future. 

CMS also announced updates to the MA Value-Based Insurance Design (VBID) model for calendar year 2020. The model will test different service delivery innovations by allowing plans to provide reduced cost sharing and additional benefits to enrollees in a more targeted fashion, bolster the rewards and incentive programs that plans can offer beneficiaries to take steps to improve their health, and increase access to telehealth services. Eligible MA health plans in all 50 states and territories may apply for the health plan innovations being tested under the VBID model, as required by the Bipartisan Budget Act of 2018.