And you thought that Medicare Part D was a big giveaway to the drug companies and PBMs….
Well this article in AISHealth.com’s Managed Care Week suggests that Part D sponsors are gearing up for intense price competition to recruit seniors and that the PDPs (participating drug plans) who will do best are those health plans that understand how to take risk.
That’s a little odd as my understanding of the PDPs’ role in part D for the first couple of years was that if they lost money the government would make up the shortfall. Of course if that’s not the case and they do lose money we could see a repeat of the stampede out of Managed Medicare of the late 1990s –not something the Administration would like to see given how confusing the Part D benefit is in the first place. To be fair I can’t find any references to who’s really at risk, and whether losses by plans will be covered if participants drug costs exceed their premium income.
If anyone does understand this, please add your wisdom into the comments! Here’s the official CMS site.