Health compliance news highlights

• The Medicare Part D 2021 deductible will increase by just over 2 percent.
• The out-of-pocket threshold (TrOOP) will increase by just over 3 percent.
• The Retiree Drug Subsidy’s cost threshold will increase by just over 2 percent while the cost limit will increase nearly 3 percent.

Will the higher TrOOP lower reinsurance payments from CMS?

Some plan sponsors contract with a Medicare Part D Prescription Drug Plan or Medicare Advantage-Prescription Drug Plan.

These plans are also known as Employer Group Waiver Plans (EGWPs).

EGWPs must meet two parts of the standard benefit design: They may not have a deductible higher than the standard deductible, and they must observe the catastrophic threshold.

CMS pays a reinsurance subsidy to plan sponsors that contract with EGWPs.

We expect that high-cost drug therapy price increases will likely be equal to or greater than the increase in the TROOP amount for most patients. That will generate similar or larger reinsurance payments for most plan sponsors.