Keeping you updated on the latest Medicare and Part D news

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CMS Announces New Part D MTM Model

Yesterday, CMS and CMMI announced a new model that will test strategies to improve medication adherence among Part D beneficiaries.  The goal of the “Enhanced Medication Therapy Management (MTM) Model” is to provide better value and improved health outcomes for Part D beneficiaries.  The enhanced model will begin January 1, 2017 with a 5 year performance period and will be tested in five different Part D regions.  Eligible stand-alone PDPs in these regions will able to vary the intensity and range of MTM services that are provided to beneficiaries, pending CMS approval.  The objectives of the model allow for PDPs to “right-size” their investment in MTM services while also allowing for the development of innovative MTM services that leverage the advantages of a given organization.  CMS is currently accepting applications from organizations that wish to participate.

Press Release
Program Site
Article (Acumen is cited a few times in here)


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National Prescription Drug Take-Back Day 9/26

This Saturday, 9/26 the 10th annual National Prescription Drug Tack-Back Day will take place in communities across the country.  The event is part of the DEA’s National Take-Back Initiative that seeks to the collect prescription drugs that are unused in people’s homes and are prone to misuse and abuse if not properly disposed of.  From 2010-2014 the initiative has collected over 4 million pounds of prescription drugs.

Event Information


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(Update) Daraprim Price to be Lowered in Response to Outrage

Clearly prompted by the AcuPartD blog, the CEO of Turing pharmaceuticals, Martin Shkreli, has backtracked on his decision to raise the price of Daraprim from $13.50 to $750 per tablet.  Shkreli has said that the move will come as a response to the anger displayed by the public, but has not said what the new price will be.  Further monitoring will be intriguing.

The story also prompted Hillary Clinton to unveil her new prescription drug plan on Tuesday that aims to prevent price-gouging by pharmaceutical companies and will allow Medicare to negotiate prescription drug prices, a problem that is explored previously in this blog.



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Daraprim Goes from $13.50 to $750 Per Tablet

Daraprim, a 62-year-old drug used mainly to treat toxoplasmosis, has become the latest drug to experience a drastic price increase.  Turing Pharmaceuticals, a startup company started by a former hedge fund manager, Martin Shkreli, acquired the drug in August and raised the price from $13.50 to $750 per tablet.  Daraprim is considered the standard of care drug for toxoplasmosis, but is also used to treat patients that have compromised immune systems, such as AIDS and cancer patients.  The price gouge is the latest in a series of seemingly arbitrary drug cost changes that has caused uproar in the medical community.

Shkreli argues that Daraprim is a rarely used drug and that the effect of the price change will be minimal, going on to say that the revenue generated from the price increase will be used to develop new drugs for toxoplasmosis with fewer side effects.  This is not the first time that Shkreli has applied this tactic.  Shkreli started a similar company in 2011, Retrophin, that bought up older drugs and raised the price.  Retrophin fired Shkreli last year and has filed a complaint with the Federal District Court in Manhattan regarding his practices.


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CMS Finds Evidence that Socioeconomic Differences within Contracts Impact Plans’ Star Ratings Measures

In an effort to address concerns voiced by Medicare Advantage (MA) organizations and Prescription Drug Plan (PDP) sponsors that a high percentage of dual eligible (DE) or low income subsidy (LIS) beneficiaries negatively effects their Star Ratings, the Center for Medicare and Medicaid Services (CMS) recently released a report that investigates the potential effects of socioeconomic factors on plans’ Star Ratings.  In the report, CMS used 2014 Star Ratings data and 16 clinical measures to find the effect that beneficiaries with an eligibility status of LIS, DE, or Disability (including overlapping combinations between the three) have on a small subset of Star Ratings measures.

In the report, CMS uses odd ratios to determine the relationship between performance and socioeconomic factors within contracts.  CMS found that out of 16 measures of performance, 12 are negatively associated with LIS/DE status.  Similarly, 11 out of 15 are negatively associated with Disability status.  The remaining measures of performance were either positively associated or showed no significant association.  The results are mixed, but CMS found that there is evidence of differences in performance between LIS/DE and non-LIS/DE, and Disabled and non-Disabled beneficiaries within contracts.  CMS concludes that these particular socioeconomic indicators do have an effect on the small subset of Star Ratings measures that were analyzed, however the effect is small and not consistently negative.