CMS Releases Proposed Rule for 2025 Medicare Advantage, Prescription Drug Plans
(Nov. 10, 2023) – This week, the Centers for Medicare & Medicaid Services proposed changes to the Medicare Advantage and prescription drug programs for the contract year 2025. These changes are intended to:
- Improve access to behavioral health care
- Ensure agents and brokers enroll individuals in the best plan for their needs
- Make sure Medicare Advantage plans offer appropriate supplemental benefits
- Streamline enrollment for individuals dually eligible for Medicare and Medicaid
- Provide an annual review of MA utilization management policies for health equity considerations
Among other changes, the proposed rule:
- Streamlines the appeals process for enrollees if their MA plan terminates coverage for certain post-acute care services
- Standardizes the appeals process for MA Risk Adjustment Data Validation audit findings
- Limits out-of-network patient cost-sharing for certain plans serving dually eligible enrollees
- Gives Part D plans more flexibility to substitute biosimilars for reference drug products
For more on the rule, see the CMS fact sheet.
--Shannan Flach