Upcoming Webinar May 10 on Medicare Advantage Reform

Join Aimed Alliance and the National Minority Quality Forum on May 10, 2024 at 12PM ET for a Webinar on Medicare Advantage Reform

In 2023, Medicare Advantage plans provided coverage for up to 30.8 million individuals, constituting over half of Medicare-eligible lives.[1] Medicare Advantage plans also continue to represent an increasingly diverse percentage of the older population, with 69 percent of Latino, 65 percent of Black, and 60 percent of Asian Medicare-eligible persons opting for Medicare Advantage over Original Medicare coverage.[2] Medicare Advantage plans are also more likely to have enrollees over the age of 75 compared to Original Medicare.[3] Given these trends, it is increasingly important to review the incentives driving plans to offer Medicare Advantage coverage and consider extending protections within traditional Medicare to Medicare Advantage plans.

Among the many protections provided to traditional Medicare enrollees is the prohibition of step therapy. Step-therapy policies, often known as “fail first,” require patients to try and fail on alternative treatments, potentially causing adverse effects, before the plan will cover the originally prescribed treatment.[4] Such policies can be unethical and inconsistent with established standards of care, as they may interfere with the patient-provider relationship and compromise patient health outcomes. Unfortunately, a 2019 rule from the Centers for Medicare and Medicaid Services (CMS) has permitted Medicare Advantage plans to impose step therapy where traditional Medicare is not.

This decision stands in stark contrast to the practices of thirty-six states, which have recognized the need for reasonable guardrails to ensure plan utilization management tactics provide a feasible and meaningful avenue to bypass step-therapy policies when medically warranted.[5] Consequently, the lack of guardrails on step therapy for Medicare Advantage beneficiaries exposes consumers to a variety of policies that can negatively impact consumer well-being. Similarly, other cost-saving measures, such as prior authorization and drug negotiation, can also impose unintended barriers on patients trying to access their medications.

This webinar seeks to educate patients, providers, caregivers, and advocates on the distinctions between Medicare Advantage and traditional Medicare, the incentives motivating plans to provide coverage for patients with chronic conditions, the repercussions of cost-saving initiatives that are not consumer-focused, and opportunities for engagement and reform.

SPEAKERS

Adina Lasser, Public Policy Manager, Alliance for Aging Access – Ms. Lasser serves as the Public Policy Manager at the Alliance for Aging Research. As Public Policy Manager, she works directly with Congressional staff and key federal agencies, like the Food and Drug Administration and the Center for Medicare and Medicaid Services, to ensure that bills and regulations reflect the voice and priorities of older adults.

Dr. Jeannie Fuglesten Biniek, Associate Director Program on Medicare Policy, Kaiser Family Foundation – Jeannie Fuglesten Biniek is an Associate Director for the Program on Medicare Policy at KFF. She focuses on providing analyses used to develop data-driven approaches to pressing national health policy issues, including the role of Medicare Advantage, the delivery and financing of care for people who are eligible for both Medicare and Medicaid, Medicare spending trends and efforts to reform provider payment. Her work has been published in Health Affairs and JAMA and cited by The Washington Post, The New York Times and USA Today, among others. She has also testified on health policy issues before Congress.

Dr. Fuglesten Biniek previously worked as an economist on the staff of the U.S. Senate Budget Committee during the passage and initial implementation of the Affordable Care Act. She also held positions at the Health Care Cost Institute, the Center on Budget and Policy Priorities, NERA Economic Consulting and Bienestar Human Services.

Dr. Fuglesten Biniek received a bachelor’s in economics from UCLA, a master’s in applied economics from Johns Hopkins University and a Ph.D. in health policy with a concentration in health economics from Harvard University.