Trump Administration Continues to Keep Out-of-Pocket Drug Costs Low for Seniors

July 30, 2020

On July 29, CMS announced the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy. Under the leadership of President Trump, for the first time seniors that use insulin will be able to choose a prescription drug plan in their area that offers a broad set of insulins for no more than $35 per month per prescription.

The average basic Part D premium will be $30.50 in 2021. The 2021 and 2020 average basic premiums are the second lowest and lowest, respectively, average basic premiums in Part D since 2013. This trend of lower Part D premiums, which have decreased by 12 percent since 2017, means that beneficiaries have saved nearly $1.9 billion in premium costs over that time. Further, Part D continues to be an extremely popular program, with enrollment increasing by 16.7 percent since 2017.

“At every turn, the Trump Administration has prioritized policies that introduce choice and competition in Part D,” said CMS Administrator Seema Verma. “The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month. In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs.”

In addition to the $1.9 billion in premium savings for beneficiaries since 2017, the Trump Administration has produced substantial Part D program savings for taxpayers. With about 200 additional standalone prescription drug plans and 1,500 additional Medicare Advantage plans with prescription drug coverage joining the program between 2017 and 2020, and that trend expected to continue in 2021, increased market competition has led to lower costs and lower Medicare premium subsidies, which has saved taxpayers approximately $8.5 billion over the past four years.

Earlier this year, CMS launched the Part D Senior Savings Model, which will allow Medicare beneficiaries to choose a plan that provides access to a broad set of insulins at a maximum $35 copay for a month’s supply. Starting January 1, 2021, beneficiaries who select these plans will save, on average, $446 per year, or 66 percent, on their out-of-pocket costs for insulin. Beneficiaries will be able to choose from more than 1,600 participating standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage, all across the country this open enrollment period, which runs from October 15 through December 7. And because the majority of participating Medicare Advantage plans with prescription drug coverage do not charge a Part D premium, beneficiaries who enroll in those plans will save on insulin and not pay any extra premiums.

In January 2020, CMS, through the Part D Payment Modernization Model, offered an innovative new opportunity for Part D plan sponsors to lower costs for beneficiaries, while improving care quality. Under this model, Part D sponsors can better manage prescription drug costs through all phases of the Part D benefit, including the catastrophic phase. Through the use of better tools and program flexibilities, sponsors are better able to negotiate on high cost drugs and design plans that increase access and lower out-of-pocket costs for beneficiaries. For CY 2021, there will be nine plan options in Utah, New Mexico, Idaho and Pennsylvania that participate in this model.

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value. CMS has taken steps to modernize the Part D program by providing beneficiaries the opportunity to choose among plans with greater negotiating tools that have been developed in the private market and by providing patients with more transparency on drug prices. Improvements to the Medicare Part D program that CMS has made to date include:

  • Beginning in 2021, providing more information on out-of-pocket costs for prescription drugs to beneficiaries by requiring Part D plans to provide a real time benefit tool to clinicians with information that they can discuss with patients on out-of-pocket drug costs at the time a prescription is written
  • Implementing Part D legislation signed by President Trump to prohibit “gag clauses,” which keep pharmacists from telling patients about lower-cost ways to obtain prescription drugs
  • Beginning in 2021, requiring the Explanation of Benefits document that Part D beneficiaries receive each month to include information on drug price increases and lower-cost therapeutic alternatives
  • Providing beneficiaries with more drug choices and empowering beneficiaries to select a plan that meets their needs by allowing plans to cover different prescription drugs for different indications, an approach used in the private sector
  • Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars,” which will lower the out-of-pocket cost of these innovative medicines for these beneficiaries
  • Empowering Medicare Advantage to negotiate lower costs for physician-administered prescription drugs for seniors for the first time, as well allowing Part D plans to substitute certain generic drugs on plan formularies more quickly during the year, so beneficiaries immediately have access to the generic, which typically has lower cost sharing than the brand
  • Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available for beneficiaries

For More Information:

  • Part D Senior Savings Model webpage
  • Ratebooks & Supporting Data webpage: View the 2021 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks

CMS and CDC Announce Provider Reimbursement Available for Counseling Patients to Self-Isolate at Time of COVID-19 Testing

July 30, 2020

On July 30, CMS and the Centers for Disease Control and Prevention (CDC) are announcing that payment is available to physicians and health care providers to counsel patients, at the time of Coronavirus Disease 2019 (COVID-19) testing, about the importance of self-isolation after they are tested and prior to the onset of symptoms.

The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic, and asymptomatic individuals emphasizing the importance of education on self-isolation as the spread of the virus can be reduced significantly by having patients isolated earlier, while waiting for test results or symptom onset. The CDC models show that when individuals who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86 percent reduction in the transmission of the virus compared to a 40 percent decrease in viral transmission if the person isolates after symptoms arise.

Provider counseling to patients, at the time of their COVID-19 testing, will include the discussion of immediate need for isolation, even before results are available, the importance to inform their immediate household that they too should be tested for COVID-19, and the review of signs and symptoms and services available to them to aid in isolating at home. In addition, they will be counseled that if they test positive, to wear a mask at all times, and they will be contacted by public health authorities and asked to provide information for contact tracing and to tell their immediate household and recent contacts in case it is appropriate for these individuals to be tested for the virus and to self-isolate as well.

CMS will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS for counseling services no matter where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.

For More Information:

Webinar Series: DRCHSD COVID Financial Recovery Webinar Series with BKD

Part I: How to Keep Your Funding

Description: This session is designed to provide rural hospital and clinic leaders with information needed to retain COVID funding and prepare for a single audit. BKD will recommend best practices for procedures, documentation and example methodologies for tracking various funding sources, revenues and expenses related to COVID.  

BKD Speaker(s): Travis Skinner, Ally Jackson, and Ryan O’Grady

Part II: Current Funding Guidance and Cost Report Implications

Description: Staying up-to-date on funding opportunities and associated guidance has been a challenge for all hospital leaders. BKD’s subject matter experts will share the most current information on funding sources and explore the potential downstream impact on the hospital’s the cost report.

BKD Speaker(s): Derek Pierce, Krystal Creach, Julia Mast, and Steve Parde

Part III: Operational Considerations 

When: Friday, July 31, 2020 at 11:00 AM CST

Description: Hospitals and clinics are eager to resume operations and reach pre-COVID volumes as quickly as possible. However, with threat of a possible COVID resurgence, labor disruptions and community uncertainty, the rebound is slower than expected.

BKD Speaker(s):Kevin Rash and Jaimie Pham

Part IV: Revenue Cycle Strategies 

When: Friday, August 7, 2020 at 11:00 AM CST

Description: BKD will review the revenue cycle strategies rural hospital leaders should be aware of as they determine how to prioritize and address any backlog in revenue cycle. This session will provide leaders example of how to prioritize A/R, opportunities for uninsured COVID reimbursement programs and discuss how to manage remote staff productivity.

BKD Speaker(s): Deb Kozlowski and Brenda Christman

Part V: Physicians: Strategic Planning

When: Friday, August 14, 2020 at 11:00 AM CST

Description: Proper alignment with employed and affiliated physicians continues to present challenges, especially to rural providers. With growing practice subsidies and recruitment and retention difficulties, hospital leaders must engage at a deeper level with the medical staff to achieve sustainable arrangements.

BKD Speaker(s): Randy Biernat and Mark Blessing

Small Rural Hospital and Clinic Finance 101

Updated June 2020, this manual was developed for use by state Medicare Rural Hospital Flexibility (Flex) Program personnel as well as small rural hospital and clinic staff/boards. The content is designed to be non-technical, and provide answers to frequently asked questions regarding critical access hospital, small rural hospital, and rural health clinic finance and financial performance. Example topics include:

  • Government Health Care Reimbursement
  • CAH Finances
  • Improving CAH Financial Performance
  • Prospective Payment System (PPS) Finances
  • RHC Finances

View the manual here!

HRSA Health Center Program Bulletin

Latest News

  • Health Center Program COVID-19 Survey Update
    Beginning with this Friday’s survey, you will now receive an email confirming that you’ve successfully submitted the survey. This change is in response to your feedback that a confirmation would be helpful. In order to do this, we require the submitter to include their email address. (Primary Care Associations will see this change next week.)
  • Deadline Extended: Provider Relief Fund
    Eligible Medicaid, CHIP, and dental providers who had not yet received a payment from the $50 billion General Distribution have the opportunity to apply for COVID-related relief by Monday, August 3.
  • Considerations for Health Center Scope of Project and the COVID-19 Public Health Emergency
    We’ve consolidated existing information about scope of project as it relates to the COVID-19 public health emergency onto a single webpage. It does not include any new guidance. Instead, it provides a single place for resources about scope of project and COVID-19.
  • Frequently Asked Questions
    We recently updated our COVID-19 FAQ webpage, adding: Who can health centers contact if they are unable to obtain COVID-19 testing supplies or equipment? We also continually update our page for coronavirus-related funding FAQs. Our COVID-19 Information for Health Centers and Partners webpage now includes links to Provider Relief Fund FAQs/resources.
  • Visit our Technical Assistance Calendar for upcoming sessions related to COVID-19 and other important topics.


If you have questions about the Health Center Program and COVID-19, please contact Health Center Program Support online. Select “Coronavirus Inquiries (COVID-19)” as the issue type—the third option on the “Health Center or EHBs Question” screen.

You can also call Health Center Program Support at 877-464-4772, option 2, 7:00 a.m. to 8:00 p.m. ET, Monday-Friday (except federal holidays).


Equitably Re-envisioning Health Input Requested

Missouri Foundation for Health is currently part of a partnership with the Rippel Foundation, regarding a project called FORESIGHT.

The initiative is a first of its kind attempt to design a bold, new future for health—together. FORESIGHT is a catalyst for equitably re-envisioning health using a “futuring” process that includes the voices of thousands of people across the U.S. The goal is to co-design the paths and partnerships that will lead to a better future, and then to begin to implement those ideas.

Currently, the project has an active survey that we are pushing out to everyone: community partners, general public, everyone. To move forward as a country, we need everyone’s input on what they would like the future to look like. There are no right or wrong answers in the survey. In fact, most of it is open-ended questions. If you all have time, this took me about 30 minutes or so to complete, it would be great if you all contributed. You also should feel free to pass this on, share on social media if you want, etc. To start, just click to add your voice and perspectives!

Federal Office of Rural Health Policy Announcement

July 30, 2020

National Advisory Group on Rural Health Meets Virtually TodayThe public is invited to join the National Advisory Committee on Rural Health and Human Services online from noon until 5:00 pm ET July 30, 2020.  The committee of more than 20 rural health experts from across the country convenes twice each year to examine rural health issues and make recommendations to the U.S. Department of Health & Human Services.  Past meetings have covered topics such as Adverse Childhood Experiences, the impact of suicide, and challenges to maternal and obstetric care. 

HHS Coronavirus Data Hub.  Last week, the U.S. Department of Health & Human Services (HHS) launched a website with data on the COVID-19 response at federal, state, and local levels.  The hub includes estimated and reported hospital capacity by state, with numbers updated daily.

Federal Office of Rural Health Policy FAQs for COVID-19.  A set of Frequently Asked Questions (FAQs) from our grantees and stakeholders, updated regularly. 

COVID-19 FAQs and Funding for HRSA Programs.  Find all funding and frequently asked questions for programs administered by the Health Resources and Services Administration (HRSA).

CDC COVID-19 Updates.  The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, including a section specific to rural health care providers, patients, and community-based organizations.  New this week:  COVID-19 Toolkit for Tribal CommunitiesAnd, in its latest Morbidity and Mortality Weekly Report, the CDC estimates that more rural counties have a higher prevalence of five underlying medical conditions – chronic obstructive pulmonary disease, cardiovascular disease, diabetes, chronic kidney disease, and obesity – associated with increased risk of severe COVID-19-associated illness. 

GHPC’s Collection of Rural Health Strategies for COVID-19.  With support from the Federal Office of Rural Health Policy (FORHP), the Georgia Health Policy Center (GHPC) provides reports, guidance, and innovative strategies gleaned from their technical assistance and peer learning sessions with FORHP grantees.

Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties.  The RUPRI Center for Rural Health Policy Analysis provides up-to-date data and maps on rural and urban confirmed cases throughout the United States.  An animated map shows the progression of cases beginning January 21.

Rural Response to Coronavirus Disease 2019.  The Rural Health Information Hub posted a guide to help you learn about activities underway to address COVID-19.  New this week:  Rural Healthcare Surge Readiness a tool developed by the COVID-19 Healthcare Resilience Working Group that helps rural healthcare facilities prepare for and respond to a COVID-19 surge.  The tool provides the most up-to-date resources for rural healthcare systems preparing for and responding to a COVID-19 surge in a range of healthcare settings (EMS, inpatient and hospital care, ambulatory care, and long-term care) and covers a range of topics including behavioral health, healthcare operations to telehealth, and more.