Addressing high prices of drugs covered under Medicare Part B. The Commission makes recommendations to address high launch prices for certain accelerated approval drugs with limited clinical evidence, the lack of price competition among products with therapeutic alternatives, and the financial incentives associated with the percentage add-on to Medicare Part B’s payment rate.
Assessing postsale rebates for prescription drugs in Medicare Part D. Using data newly available to the Commission as a result of the Consolidated Appropriations Act, 2021, the Commission discusses trends and issues associated with the rapid growth of negotiated rebates and discounts received by Part D plan sponsors.
Standardized benefits in Medicare Advantage plans. The Commission discusses the challenges that beneficiaries face in comparing Medicare Advantage (MA) plan benefits and selecting the plan with benefits that best meet their needs, and we outline an approach for standardizing MA benefits.
Favorable selection and future directions for Medicare Advantage payment policy. The Commission discusses the effects of favorable selection on payments to MA plans and alternative approaches to setting MA benchmarks that would be less reliant on fee-for-service (FFS) spending than the current system is.
Disparities in outcomes for Medicare beneficiaries with different social risks. The Commission presents an analysis of outcome measures for Medicare beneficiaries stratified by race/ethnicity and low-income status and discusses approaches to account for differences in patients’ social risk factors and to encourage providers to focus on reducing health disparities.
Congressional request: Behavioral health services in the Medicare program. In response to a congressional request, the Commission presents an analysis of utilization and spending for behavioral health services and discusses trends and issues in inpatient psychiatric care for beneficiaries.
Mandated report: Telehealth in Medicare. As mandated by the Consolidated Appropriations Act, 2022, the Commission presents data on the use of telehealth services during the public health emergency and an analysis of the relationship between expanded telehealth coverage and quality, access, and costs.
Aligning fee-for-service payment rates across ambulatory settings. The Commission recommends more closely aligning Medicare payment rates across ambulatory settings—hospital outpatient departments, ambulatory surgical centers, and freestanding physician offices—for selected services.
Reforming Medicare’s wage index systems. The Commission discusses the inaccuracies and inequities of Medicare’s wage indexes and recommends a wage index approach for all of Medicare’s prospective payment systems that would result in more accurate and equitable payments across providers.
Mandated report: Evaluation of a prototype design for a post-acute care prospective payment system. As mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Commission presents an evaluation of a prototype design of a uniform prospective payment system for post-acute care providers—skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.