Accepting Medicare Part D Risk

Providers interested in risk contracts with Medicare Advantage payers often struggle with the decision of whether to take on risk in Part D or whether to carve it out. If you are a provider considering such an arrangement, here are a few key questions to ask yourself prior to agreeing to take risk on Part D:

Do I have a large enough population?

The Centers for Medicare and Medicaid Services deems a Part D population credible at 56,000 member months (or 4,667 average members). This relatively large threshold is due to the low frequency and high severity of extremely costly specialty medications, which make Part...