Looming Medicare Changes, Rethinking Healthcare Value Assessment Focus of Live Event

With Medicare prescription-drug benefits on the brink of major changes in 2025, Part D drug plan beneficiaries need to be aware of options in order to minimize their costs at the pharmacy counter in the coming months. Sponsored by the Alliance and produced in partnership with The Hill, the program, “Bang for Your Buck: Get the Most from Your 2025 Medicare Drug Benefits” detailed major changes in store for the Medicare Part D drug plans, and explored a new metric utilizing real-world evidence to measure value. More than 78,000 tuned in online on October 22.

Following a showing of the Alliance’s latest educational film, How Medicare Drug Coverage Changes Will Impact You in 2025, Alliance President & CEO Sue Peschin kicked off the event with the sponsor segment interview with Joe Ruffolo, Senior Vice President & General Manager of The Hill, stressing the need for beneficiaries to be aware of two major changes: a $2,000 cap on out-of-pocket costs for prescription drugs, and the opportunity to smooth out-of-pocket costs into monthly payments over the plan year.

“Medicare Open Enrollment is happening now and runs through December 7 and more than any other year we recommend that current beneficiaries and those signing up for the first time pay special attention to reviewing their Part D drug plan offerings,” said Peschin. “If you’re a current beneficiary or helping someone who is, this is the year to review your plans to be sure it will still provide the best coverage for your prescriptions at your preferred pharmacy for 2025.”

Peschin also detailed a new report from the Alliance released in partnership with Milliman, proposing a new metric for assessing value: “A new framework for quantifying healthcare value using real-world evidence.”

“We thought it would be interesting to work with Milliman…and they helped us to come up with a sample framework called SoLV – Standard of Living Valuation – and it’s a new approach to assessing value,” said Peschin. “As we go into the second round of [drug price] negotiations which is going to happen at the beginning of February, beneficiaries can really advocate for the use of other types of patient-centered frameworks like SoLV. We’re not saying it’s the only way to go but it’s a great way that is non-discriminatory and ensure that the unique needs of older adults and those with disabilities aren’t discounted and that they’re considered in the process.”

For the headliner interview, Bob Cusack, Editor in Chief of The Hill shared an interview with Bruce Pyenson, Former Principal & Consulting Actuary with Milliman, and former MedPAC Commissioner, who headed the report.

“The issue of value is really more fundamental and will start to come up more and more as we look at the outrageous spending on healthcare in the U.S. economy,” said Pyenson. “It turns out that health care itself – medical care – is not the biggest determinant of how healthy people are. The biggest determinant of how healthy people are is their standard of living, and their education, their housing, their wages, their opportunity for recreation, transportation. It’s those socioeconomic drivers that are much more important for health outcomes.”

A panel discussion, moderated by Cusack, included the following panelists:

• Tom Kornfield, Founder & CEO, MAST Health Policy Solution: “The benefit is changing tremendously in terms of the out-of-pocket cap and monthly prescription payment plan…and I think that protection for enrollees is one of the major changes for next year. It’s important for beneficiaries to shop around and make sure their prescriptions are covered.”
• Amy Niles, Chief Mission Officer, PAN Foundation: “One of the key messages today is the importance of Open Enrollment.  There never has been a more important time to evaluate one’s plan. We have about 2 million plus seniors who are facing plans that are no longer going to exist in 2025 or major changes so it is really important for people to take the time. And we know for the most part, 7 out of 10 seniors are not taking time to review their plan, so that is an important message. At the PAN Foundation, we did a national poll of people on Medicare and we found that 9 out of 10 individuals were not aware of the two reforms.”
• Dr. Gary Puckrein, President and CEO, National Minority Quality Forum: “It’s time to reimagine the system because the one we’ve got is completely broken.”
• Schrieber: “Every year we say to beneficiaries to review their annual notice of change that outlines how the plan might change from year to year and to connect with a counselor if they’re interested in seeing what other options are out there. And then I would also just emphasize looking into financial assistance programs because there’s a lot of programs that can help cover the cost of Medicare that are actually underutilized.”

Watch the full recording and read a recap in The Hill.

Photos by Kristoffer Tripplaar.