CMS eyeing Part D performance measures.(Practice Trends)

WASHINGTON -- Medicare intends to use performance measures to monitor cost, quality, and access issues related to the new prescription drug benefit, a research analyst indicated during a meeting of the Medicare Payment Advisory Commission.

However, Medicare has not yet "determined what those measures will be and how they will be used," said MedPAC analyst Cristina Boccuti. MedPAC makes recommendations to Congress on Medicare payment issues.

The Centers for Medicare and Medicaid Services will be collecting a large amount of data on the new drug benefit--or Medicare Part D--including drug utilization and plan benefit information, to construct these performance measures, Ms. Boccuti said. In addition to the agency's need for the data, "congressional agencies will need Part D data to report to the Congress on the impact of the drug benefit on cost, quality, and access," she added.

MedPAC commissioners recommended that the Department of Health and Human Services establish a process for the timely delivery of these data to interested parties.

Individuals, employers, and government agencies currently use performance measures to evaluate how well health plans and pharmacy benefit managers manage drug benefits, Ms. Boccuti said.

To identify how policy makers could use these measures to monitor the Part D program, MedPAC convened a panel of 11 experts representing health plans, pharmacy benefits managers (PBMs), employers, pharmacies, consumers, quality assurance organizations, and researchers. The panel members analyzed measures including cost control, access and quality assurance, benefit administration and management, and enrollee satisfaction.

Based on the panel's findings, CMS plans to collect data on the following: