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Part D plans take on more risk in new CMMI model

January 22, 2019 / Susan Morse

The Centers for Medicare and Medicaid Services is testing new models through the Center for Medicare and Medicaid Innovation to bring down prescription drug costs in Part D and to add benefits and increase competition in Medicare Advantage plans. Both models are voluntary. The Part D payment modernization model is aimed at giving plans an incentive to reduce costs. Currently in Part D, once a patient's prescription drug spend is high enough for the patient to enter the final phase of the benefit, known as the "catastrophic phase," Medicare is responsible for 80 percent of drug costs.