Although delayed as a result of the COVID-19 public health emergency, there are persistent and ongoing efforts to reform the Medicare Part D benefit. Since its June 2016 Report to Congress, the Medicare Payment Advisory...more
High out-of-pocket costs can be a significant barrier to access for Part D enrollees, especially for non-low-income subsidy (LIS) enrollees with a condition that requires an expensive specialty drug for treatment. The 2019...more
Current Medicare Part D policy requires sponsors to cover with limited exceptions “all or substantially all” drugs in six “protected” classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment...more
Hospitals and Health Systems Prepare for a Value-Based Future -
Editor’s Note: Hospitals and health systems are actively working to service their communities in numerous ways, including through the adoption of initiatives...more
2/22/2018
/ Antitrust Division ,
Cost-Sharing ,
False Claims Act (FCA) ,
Hospitals ,
Information Sharing ,
Medicare ,
Medicare Part D ,
No-Poaching ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Substance Abuse ,
Universal Health Services Inc v United States ex rel Escobar
Vaccination utilization among U.S. adults is low, and well below the Healthy People 2020 Targets, despite widespread availability of safe and effective vaccines and long-standing use recommendations by the Centers for Disease...more
Using Telehealth as a Tool for Health System Integration -
As discussed in our August Health Update article on patient engagement and digital health—the first in our new digital health series—the advent of digital and...more
Contracting With Technology Vendors: Obligations and Compliance Strategies -
Editor’s Note: In a recent webinar, Manatt Health examined how to protect privacy when communicating in the digital age. The session revealed how...more
7/25/2017
/ Antitrust Division ,
Business Associates ,
Centers for Medicare & Medicaid Services (CMS) ,
Digital Health ,
Employee Retirement Income Security Act (ERISA) ,
Fair Credit Reporting Act (FCRA) ,
Federal Trade Commission (FTC) ,
Health Insurance ,
Medicare ,
Mergers ,
Physician Fee Schedule ,
Spokeo v Robins ,
Vendors
The Department of Health and Human Services (HHS) has proposed a major, national payment model that would, if implemented, significantly impact how Medicare pays for drugs provided through the Part B program. Under the...more
Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace -
Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...more
7/23/2015
/ Admissions ,
Affordable Care Act ,
Anticompetitive Agreements ,
Attorney General ,
Biologics ,
Biosimilars ,
Caregivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Decision-Making Process ,
Department of Justice (DOJ) ,
DSRIP ,
FDA Approval ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Healthcare.gov ,
Home Health Care ,
Home Healthcare Workers ,
Hospitals ,
Long-Term Care ,
Medicaid ,
Medical Malpractice ,
Medicare ,
Medicare Part B ,
Nurses ,
Patient Rights ,
Physicians ,
Prescription Drug Coverage ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Settlement ,
Sherman Act ,
State Health Insurance Exchanges
On April 15, 2015, CMS issued a preliminary recommendation for a HCPCS code for Zarxio, the first biosimilar product ever to be approved by the FDA. CMS’s recommendation provides the first indication of how the agency will...more
The President has signed into law the bipartisan bill H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently repeals the flawed Sustained Growth Rate (SGR) formula and replaces it with a stable...more