FOR IMMEDIATE RELEASE
Contact:  Andrew Rosenberg (arosenberg@thornrun.com), (202) 247-6301
​
The Centers for Medicare and Medicaid Services (CMS) should take immediate steps to curtail the practice of recommending lifetime use of addictive pain medications for individuals who set up Workers’ Compensation Medicare Set-Aside Arrangements (MSAs), according to a recent letter from the Medicare Advocacy Recovery Coalition (MARC). 
​

Today, Medicare Advocacy Recovery Coalition (MARC) Chairman Greg McKenna submitted a comment letter to CMS Administrator Seema Verma in response to the proposed rule entitled ​"Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program." In the letter, Chairman McKenna applauded CMS' ​initiatives to address the nation's opioid epidemic, and stressed that CMS must to ensure that frequently abused drugs are appropriately managed so that Medicare beneficiaries at risk of abuse and addiction cannot access them through the Part D program. "We write today to urge CMS in both its final rule and in the final rule preamble to address how frequently abused drugs could be accessed through Workers Compensation Medicare Set Aside arrangements (MSAs)," wrote Chairman McKenna. 

​Congress has shifted its full focus to tax reform as leadership scrambles to pass an overhaul of the nation’s code before the end of the year. Following several days of around-the-clock negotiations and speculation, The House GOP released the legislative text for H.R. 1 – The Tax Cuts and Jobs Act (TCJA) (text; section-by-section), signaling a significant step forward in the GOP’s push for a major overhaul of the nation’s tax code. The bill passed out of the House Ways and Means Committee last week, and heads to the House floor for debate and final passage by the end of this week, The Senate’s version of TCJA is slated to be marked up this week in the Finance Committee. 

​Welcome to The MARC Monitor, your monthly update on federal secondary payer policy. As you may know, the Medicare Advocacy Recovery Coalition (MARC) is a national coalition advocating for the improvement of the Medicare and Medicaid Secondary Payer (MSP) programs. Each month, we’ll be bringing to your inbox the latest news, activities, and alerts on the issues that are driving the day in Washington on MSP. 

In an article published in CLM Magazine, MARC members Greg McKenna and Heather Sanderson discuss how the SPARC Act (H.R. 1122) could bring needed changes to improve the Medicare Secondary Payer (MSP) law. "When Congress created the Part D program in 2003 as part of the Medicare Modernization Act (MMA), it failed to address secondary payer issues beyond simply stating that Part D Prescription Drug Plans' secondary payer rights were 'in the same manner' as Medicare Advantage Plans," they wrote, adding that "this process is inefficient and costly to enforce."

The authors go on to explain that the SPARC Act "would make clear who is responsible for prescription drug costs and when they must be reimbursed. It would also clarify when that responsibility begins, how a prescription drug plan (PDP) can recover past payments, and when and how CMS must share data to help facilitate the secondary payer recovery process." McKenna and Sanderson conclude that the SPARC Act "would provide commonsense reforms to improve healthcare outcomes for Medicare Part D beneficiaries, insurance carriers, and PDPs."

​It is hard to imagine that in 2003, when Congress enacted the Medicare Modernization Act (MMA) and created the Medicare Prescription Drug Program (the “Part D” program), nobody really knew whether beneficiaries would actually sign up. Nor did Congress know whether, or how, the law would actually work.
 
The CMS administrator at the time, Tom Scully, famously noted that a prescription drug program “does not exist in nature.”[1] In fact, at the time no model existed for a federally subsidized private insurance program, and there was nothing the Congress could use as a template. At best, Congress looked to the Medicare Advantage program as a guide for several of the operational aspects of the new Part D program. But even that was a poor analog.

​The Medicare Advocacy Recovery Coalition (MARC) today lauded Rep. Tim Murphy (R-PA) and Ron Kind (D-WI) for their introduction of the Secondary Payer Advancement, Rationalization, and Clarification (SPARC) Act (H.R. 1122) – a bipartisan measure to improve the Medicare Secondary Payer (MSP) program in Medicare Part D. While the MSP policy is designed to ensure that the Medicare program and prescription drug plans (PDPs) do not reimburse healthcare expenses for which another entity is legally responsible, literally every stakeholder agrees that the process by which PDPs recapture payment for claims that were not its responsibility to pay is broken. The SPARC Act will significantly improve the efficiency of the current system, providing a clear framework for communication among all stakeholders involved.

​Medicare Advantage Plans (MAPs), also known as Medicare “Part C,” are private insurance plans that provide a Medicare beneficiary’s “Part A” and “Part B” benefits. A Medicare beneficiary can choose to enroll in a MAP rather than traditional Medicare. Part D plans provide benefits for a Medicare beneficiary’s prescription drugs. It is important to note that traditional Medicare generally does not provide prescription coverage directly; a beneficiary must enroll in a Part D plan to receive Part D benefits.