CMS’s recent final Medicare Advantage and Part D rule imposes a number of key new requirements that will impact MA and Part D plans in 2015 and beyond. Among the changes ahead: unprecedented disclosures of pricing methodologies, new price concession transparency and preferred cost sharing requirements, new regulation of agent and broker commissions, and new rules mandating the release of certain records to CMS. Find out what provisions in the final rule will have the greatest impact on your organization and how plan sponsors can prepare for the upcoming changes.
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JODY STERN, R.Ph., is program manager with ATTAC Consulting Group. As the pharmacy practice head for the national Medicare Part D consultants, Ms. Stern has led clients addressing Medicare Part D, Medicaid, commercial, Health Exchange (QHP) and specialty drug management, and PBM oversight and management issues. Ms. Stern’s expertise combines exceptional clinical and research experience with over 24 years of operational management of pharmacy programs including formulary design and management, drug utilization program and intervention design, Medicare Part D coverage determinations, exceptions, MTM programs, transition and therapeutics management. Ms. Stern previously held pharmacy program management positions with Aetna, Inc., Prudential Health Care and Integrated Pharmacy Solutions, Inc.
SHELLY BRANDEL is a principal and consulting actuary with the Milwaukee office of Milliman. Shelly’s area of expertise is in both managed and traditional health care programs, with more than 15 years of experience in these areas. She has assisted commercial, Medicare and Medicaid health plans as well as state and federal Medicaid agencies. Shelly has helped clients with product development and pricing, provider reimbursement and risk-sharing arrangements, experience analysis, valuation of reserves, and financial projections. Examples of Shelly’s expertise include assisting Medicare Part D carriers with their annual bid development and strategy, performing Medicare Part D competitive research for the firm, preparing commercial health plan Affordable Care Act rate filings and financial projections, and reviewing the development of Medicaid payment rates for Financial Alignment Demonstration programs for dual eligibles in several states. She is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries. She received her Bachelor of Science degree in mathematics and statistics from the University of Miami, Ohio.
Moderator: Lauren Flynn Kelly, editor of AIS’s Drug Benefit News