Medicare FFS beneficiary service use and associated payments to providers dropped substantially from mid-March through mid-April, but had returned to near-2019 levels by the fall of 2020. The rebound in the fall was not sufficient to offset the earlier declines in the spring, and cumulative payment levels across all states were lower in 2020 compared to 2019.
Experience during the first six months of the pandemic shows that the risks of Medicare fee-for-service (FFS) beneficiaries contracting COVID-19 and subsequent hospitalization and mortality vary significantly by demographic characteristics, health status, and nursing home residence. There are several factors that indicate significantly elevated risk.
The United States relies on the interactions of private entities – drug manufacturers, health plans and pharmaceutical benefit managers (PBMs) - to achieve value by negotiating prices, operating formularies and implementing other benefit management strategies. The U.S. does not establish or negotiate prices for prescription drugs, as do some other countries. A critical part of the U.S.
Market-based payment policies such as competitive bidding, reference pricing, centers of excellence and tiered provider networks have been implemented both in Medicare and across the private sector, as described in this report required by Executive Order 13890.
The September 13, 2020 Executive Order on Lowering Drug Prices by Putting America First declared, “It is the policy of the United States that the Medicare program should not pay more for costly Part B or Part D prescription drugs or biological products than the most-favored-nation price.” The Most Favored Nation (MFN) Model issued by the Centers for Medicare & Medicaid Services (CMS) on No
CHANGES IN HOME HEALTH CARE USE IN MEDICARE ADVANTAGE COMPARED TO TRADITIONAL MEDICARE, 2011-2016 Stephen Zuckerman, Laura Skopec, Joshua Aarons, Robert A. Berenson, Judith Feder, and Douglas Wissoker Urban Institute Peter J. Huckfeldt