TAMING HEALTH CARE 'MIDDLEMEN' - The Biden administration wants to cap the amount insurers can pay Medicare Advantage brokers and agents per enrollee, POLITICO's Robert King reports. The administration also took another step toward reducing drug prices for older Americans.
CMS proposed a rule late Monday limiting the amount paid to brokers and agents to $632 per enrollee - $31 more than the current limit. But the new cap would include any external fees that companies pay brokers and agents as incentives to sell more expensive plans.
"Many people with Medicare rely on agents and brokers to help them make the best choice about their health care coverage," said CMS Administrator Chiquita Brooks-LaSure during a call with reporters Monday. "However, we are concerned that some Medicare Advantage plans are compensating agents and brokers in a way that circumvent existing payment rules."
Caps per enrollee are nothing new. CMS annually limits how much an insurer can pay a broker and agent for each Medicare Advantage plan sold. But now, insurers can compensate those who sell plans with unrelated fee payments not calculated as part of the cap.
The proposed rule comes less than two weeks after more than a dozen Democratic senators raised the alarm about such marketing strategies, which they critically characterized as "middlemen" in a letter to CMS. The senators additionally asked CMS to prohibit Medicare Advantage marketers from selling beneficiary information to each other.
The rule would also give Medicare Part D enrollees easier access to biosimilars, which would lower patient drug costs. Biosimilars are typically much cheaper than the first-approved biologic drugs they mimic. Right now, Part D beneficiaries must get CMS approval for biosimilar alternatives, but the proposed rule would eliminate the requirement.
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