In mid-February 2019, at the American Medical Association’s National Advocacy Conference, Demetrios Kouzoukas, principal deputy administrator at the Center for Medicare and Medicaid Services (CMS) and director of the Center for Medicare, noted that the Trump administration is making transparency a “priority” as it begins to embrace policies like step therapy.
During the CMS Update keynote, Kouzoukas noted that the agency is working across the healthcare system to ensure physicians and patients are more informed about the Part D formularies and the options they have available to them when it comes to prescription drugs. In addition to Part D, the agency wants to bring the same transparency mindset to traditional Medicare.
During another keynote speech, Health and Human Services Secretary Alex Azar also discussed some of the transparency initiatives. One such initiative was the proposal to require that Medicare Part D plans make available to the public and physicians a real-time pharmacy benefit tool. The tool would allow physicians to immediately find out which drugs are covered by the patients’ insurance, how much they cost overall, and how much they will cost your patient. Physicians will also be able to determine what kind of authorizations might be necessary and may be able to get started on the authorization in the moment.
Step Therapy
Kouzoukas echoed statements made by Secretary Azar, who said that HHS officials are working to address potential issues in step therapy, including when patients switch plans and have to start over from the bottom of the step therapy process. Azar referred to the practice as “penny-wise and pound-foolish” and that “getting a patient on the right drug, at the right time, is one of the best investments we can make in their health.”
However, despite the concerns about step therapy, Azar said CMS will continue to push forward with step therapy processes, including into the Medicare Advantage program.
Increased Transparency
Kouzoukas also referred to what he calls the “snow globe healthcare policy,” which is where government officials release new regulations and policies that shake up the healthcare system, and explained that the Administration is trying to roll out policies that would prevent that from continuing. He noted that he tries to “see the Medicare program through [the] eyes [of physicians]” and realizes that such fragmented policy roll outs can leave the doctors feeling like they are broken figures inside a snow globe.
He noted that one example of the new approach is a CMS policy change that allows Medicare to pay for remote check-ins with patients over the phone and to pay physicians for reviewing images texted to them by patients. Initially, these services were considered a type of telehealth under the statute, and Medicare did not cover them. However, when CMS took another look at its telemedicine definition, it found that it was able to expand coverage to include these services.
CMS has also worked to eliminate certain quality measures and other steps that will save roughly 300 hours per year. Some eliminated measures include reporting responsibilities of acute care hospitals that the agency determined were duplicative, “topped out” (most providers are performing highly on them), or excessively burdensome to report. CMS is hoping that this will allow providers to better focus on tracking and reporting measures that are most impactful to patient care.