AEDs are a protected class under Medicare* Part D, which means Part D sponsor formularies must include all or substantially all drugs in the following classes:1
CMS instituted this policy to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans and to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.1
CMS Five-Star Ratings strategy is aligned with CMS’ Three Aims: better care, healthier people/healthier communities, and lower costs through improvements. CMS Five-Star measures for Medicare plans cover the following categories:
- Intermediate outcomes
- Patient experience
The American Epilepsy Society, American Academy of Neurology and National Association of Epilepsy Centers created a task force with the purpose of developing quality measures for epilepsy care. This ultimately led to the Centers for Medicare and Medicaid Services (CMS) approving and implementing quality measures on January 1, 2012.2
CMS approved the following measures that would be voluntarily reported followed by a subsequent incentive payment. Physicians who failed to report these measures would be penalized 1 to 3% of Medicare reimbursement after required reporting was implemented.2
Although eight measures were approved by the task force that developed them, only three were adopted by CMS:2,3
- The frequency of each seizure type should be reported at each visit
- The etiology (or epilepsy syndrome) should be reported at each visit
- All female patients of childbearing potential (12-44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.
*Medicare does not endorse any specific products. Formulary availability does not guarantee coverage.