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Stand-Alone Medi-Pak Rx Enrollment Suspension

We recently learned that the Arkansas Blue Cross and Blue Shield stand-alone prescription drug plans (PDP) will be under an enrollment suspension for plan-year 2018. Most agents have already been trained on our 2018 senior products, which include stand-alone Medi-Pak Rx Basic and Premier. There are two points we would like to emphasize before we go into more detail:

1) Current Rx Basic and Rx Premier members are not impacted by this enrollment suspension. We cannot market our stand-alone drug plans to new members while under this suspension.

2) The suspension has no impact whatsoever on marketing Medi-Pak Advantage PFFS and HMO plans.

Frequently Asked Questions
We've anticipated some questions that you or your clients may have regarding the PDP enrollment suspension for plan-year 2018.

Q: Did Centers for Medicare and Medicaid Services (CMS) also place an enrollment suspension on Arkansas Blue Cross Medicare Advantage and Medicare supplement plans?

A: No. The enrollment suspensions only apply to Medi-Pak Rx Basic and Premier stand-alone drug plans. There are no restrictions on our Medicare Advantage PFFS, Medicare Advantage HMO or Medicare supplement plans for 2018.

Q:Will current members' Medi-Pak Rx plan be canceled?

A: No, existing Medi-Pak Rx Basic or Premier members will have their plans continue in 2018.

Q: Will there be any changes to current Medi-Pak Rx plans as a result of the CMS enrollment suspension?

A: No. Existing Medi-Pak Rx plans will not change as a result of the CMS enrollment suspension. In fact, both the Basic and Premier Rx plans will have lower monthly premiums in 2018 than in 2017.

Current members received an annual notice of change (ANOC) packet in the mail at the end of September that outlined the plan changes for 2018. The copayments, coinsurance, deductible, formulary (drug list) and pharmacy network changes reflected in the ANOC were standard plan changes similar to the updates that have been made to Medi-Pak Rx in recent years.

Current Medi-Pak Rx members will only have one restriction in 2018: they're not able to move from the Basic to the Premier plan and vice versa.

Q: Will members need to shop for a new prescription drug plan during the annual election period (AEP)?

A: Members who are satisfied with their current Medi-Pak Rx plan will not need to shop for a new plan for 2018. Arkansas Blue Cross will continue to pay prescription drug claims and provide the same high level of customer service since our members joined the plan.

Q: Is Arkansas Blue Cross doing anything to get the CMS enrollment restrictions removed?

A: Yes, we're in the process of making our Medi-Pak Rx plans more competitive by lowering premiums and reviewing benefits, as well as improving quality-of-care measures for the future.

Q: What are CMS enrollment suspensions?

A: CMS places enrollment suspensions on Medicare Advantage or Part D sponsors when they fail to meet minimum medical-loss ratio (MLR) requirements for three consecutive years.

Q: What are medical-loss ratio (MLR) requirements?

A: MLR requirements are intended to create incentives for Medicare Advantage and Part D sponsors to reduce administrative costs such as marketing, profit, agent commission and other uses of the money earned by the Medicare Advantage or Part D sponsor to help ensure that taxpayers and enrolled members receive value from Medicare plans.

A medical-loss ratio of 85 percent must be maintained for Medicare Part D plans. That means 85 cents of every dollar collected must be used to pay members’ prescription drug claims as well as activities that improve quality of care. The remaining 15 cents is used to pay administrative costs (e.g., marketing, profit, agent commission, etc.). When a Medicare Part D plan has a medical-loss ratio below 85 percent it must send rebates to the federal government.

Q: Why did CMS place enrollment suspensions on Arkansas Blue Cross Medi-Pak Rx (PDP) plans?

A: Our Medi-Pak Rx plans failed to meet the required 85 percent medical-loss ratio benchmark for three consecutive years. Simply put, each year, we overestimated the amount of money we expected to receive in prescription drug claims from members and underestimated the amount of rebates we would receive from the federal government.