October 3, 2024

One of Humana’s largest contracts dropped from 4.5 to 3.5 stars. They are attributing the drops to the increase in star rating cut points, causing them to fall just below the threshold on a few measures.

This deal is the latest move by BCSA to lower drug costs. The plan also has an unusual pharmacy benefits arrangement by contracting with several PBMs instead of just one.

The final guidance outlines requirements and parameters for how participating drug companies must ensure eligible people with Medicare prescription drug coverage will have access to the negotiated prices for 2026 and 2027, including procedures that apply to participating drug companies, Medicare Part D plans, pharmacies, mail order services, and other entities that dispense drugs covered under Medicare Part D.

Accelerated and Advance payments related to Hurricane Helene may be granted in amounts equal to a percentage of the preceding 90 days of claims payments. These payments will be repaid through automatic recoupment from Medicare claims for a period of 90 days following the issuance of the accelerated or advance payment. A demand will be issued for any remaining balance on day 91 following the issuance of the accelerated or advance payment.

Coverage includes prevention, diagnostic, and treatment services including dental, vision, hearing, and mental health services. Access to these services is due to the Medicaid Early and Periodic Screen, Diagnostic, and Treatment (EPSDT) requirements.