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Commission Recommendations

MedPAC makes recommendations to the Congress and to the Secretary of Health and Human Services on issues affecting the administration of the Medicare program. With its recommendations, the Commission strives to improve the delivery of care, while ensuring financial stability and maximizing value for the program. After extensive analysis and evaluation, our recommendations are discussed and voted on by Commissioners in our public meetings. Recommendations are typically published in two main reports, released in March and June of each year.

Recommendations	Topic(s)	Date
Medicare vaccine coverage and payment The Congress should: cover all appropriate preventative vaccines and their administration under Part B instead of Part D without beneficiary cost sharing and modify Medicare’s payment rate for Part B-covered preventative vaccines to be 103 percent of wholesale acquisition cost, and require vaccine manufacturers to report average sales price data to CMS for analysis.	Beneficiaries and coverage Drugs, Devices, and Tests	June 2021
Realigning incentives in Medicare Part D (1) The Congress should make the following changes to the Part D prescription drug benefit: Below the out-of-pocket threshold: Eliminate the initial coverage limit. Eliminate the coverage-gap discount program. Above the out-of-pocket threshold: Eliminate enrollee cost sharing. Transition Medicare’s reinsurance subsidy from 80 percent to 20 percent. Require pharmaceutical manufacturers to provide a discount equal to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
Realigning incentives in Medicare Part D (2) Concurrent with our recommended changes to the benefit design, the Congress should: Establish a higher copayment amount under the low-income subsidy for nonpreferred and nonformulary drugs. Give plan sponsors greater flexibility to manage the use of drugs in the protected classes. Modify the program’s risk corridors to reduce plans’ aggregate risk during the transition to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
Realigning incentives in Medicare Part D (3) Concurrent with our recommended changes to the benefit design, the Secretary should: Allow plans to establish preferred and nonpreferred tiers for specialty-tier drugs. Recalibrate Part D’s risk adjusters to reflect the higher benefit liability that plans bear under the new benefit structure.	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
The Medicare prescription drug program (Part D): Status report The Congress should change Part D’s coverage-gap discount to: require manufacturers of biosimilar products to pay the coverage-gap discount by including biosimilars in the definition of “applicable drugs” and exclude biosimilar manufacturers’ discounts in the coverage gap from enrollees’ true out-of-pocket spending.	Beneficiaries and coverage Drugs, Devices, and Tests	March 2018
Improving Medicare Part D (1) The Congress should change Part D to: transition Medicare’s individual reinsurance subsidy from 80 percent to 20 percent while maintaining Medicare’s overall 74.5 percent subsidy of basic benefits, exclude manufacturers’ discounts in the coverage gap from enrollees’ true out-of-pocket spending, and eliminate enrollee cost sharing above the out-of-pocket threshold.	Beneficiaries and coverage Drugs, Devices, and Tests	June 2016
Improving Medicare Part D (2) The Congress should change Part D’s low-income subsidy to: modify copayments for Medicare beneficiaries with incomes at or below 135 percent of poverty to encourage the use of generic drugs, preferred multisource drugs, or biosimilars when available in selected therapeutic classes; direct the Secretary to reduce or eliminate cost sharing for generic drugs, preferred multisource… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2016
Mandated report: Improving Medicare’s payment system for outpatient therapy services (2) To avoid caps without exceptions, the Congress should: reduce the therapy cap for physical therapy and speech-language pathology services combined and the separate cap for occupational therapy to $1,270 in 2013. These caps should be updated each year by the Medicare Economic Index. direct the Secretary to implement a manual review process for requests to… Read more »	Ambulatory care settings Beneficiaries and coverage Physicians and other health professionals	June 2013
Medicare Advantage special needs plans (2) The Congress should: allow the authority for chronic care special needs plans (C–SNPs) to expire, with the exception of C–SNPs for a small number of conditions, including end-stage renal disease, HIV/AIDS, and chronic and disabling mental health conditions; direct the Secretary, within three years, to permit Medicare Advantage plans to enhance benefit designs so that… Read more »	Beneficiaries and coverage Part C (Medicare Advantage)	March 2013
Medicare Advantage special needs plans (4) For dual-eligible special needs plans (D–SNPs) that assume clinical and financial responsibility for Medicare and Medicaid benefits, the Congress should: grant the Secretary authority to align the Medicare and Medicaid appeals and grievances processes; direct the Secretary to allow these D–SNPs to market the Medicare and Medicaid benefits they cover as a combined benefit package;… Read more »	Beneficiaries and coverage Part C (Medicare Advantage)	March 2013