On April 4, 2024, the Centers for Medicare and & Medicaid Services (CMS) announced its final 2025 Medicare Advantage and Part D Rule. The final rule includes several important revisions to improve the Medicare Advantage program, such as placing a fixed limit on compensation for agents and brokers to address problematic incentives created under the previous commission-based system. It also requires third-party marketing organizations to receive express written consent before sharing personal beneficiary data with other third-party marketing organizations. Additionally, plans will now be required to engage with beneficiaries to ensure they are aware of available supplemental benefits and how they may utilize these benefits, such as vision, hearing, fitness, and dental care.
While many of the final rule changes will benefit Medicare Advantage beneficiaries, CMS’ decision to finalize a biosimilar switch may endanger access to treatments for some beneficiaries. Under the final rule, plans are permitted to conduct mid-year formulary substitutions when a biosimilar is approved. Moreover, plans may also automatically substitute a biosimilar for a biologic irrespective of the drug’s interchangeability designation. As explained in Aimed Alliance’s 2025 Medicare Advantage comment, this policy shift could potentially result in stable beneficiaries being non-medically switched to an alternative treatment without prior notice. Therefore, it will be critical for CMS to monitor the repercussions of this change on beneficiaries’ abilities to access and maintain access to their treatments. Learn more about the final rule by reviewing the CMS 2025 Medicare Advantage Final Rule Fact Sheet.
Last Updated on April 15, 2024 by Aimed Alliance
