Bridgette Keller on Medicare Part D

CMS Publishes Final Rules Implementing Part C and Part D Program Changes

On April 23, 2024, the Centers for Medicare & Medicaid Services (CMS) published final rules setting forth Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024--Remaining...more

4/24/2024 / Agents , Beneficiaries , Brokers , Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Final Rules , Health Care Providers , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part C , Medicare Part D , Mental Health , Prescription Drugs , Social Security Act

Senate Democrats Pass Long-Awaited Drug Pricing Reforms in Budget Reconciliation Bill

On August 7, 2022, after extensive deliberation, Senate Democrats passed their long-awaited reconciliation bill, the Inflation Reduction Act of 2022 (the Reconciliation Bill). In addition to climate and tax provisions, the...more

8/10/2022 / Anti-Kickback Statute , Biosimilars , Budget Reconciliation , Drug Pricing , Medicare , Medicare Part D , Out-of-Pocket Expenses , Pharmacy Benefit Manager (PBM) , Price Inflation , Transparency

CMS Moves Forward with its D-SNP Proposals in its CY 2023 Medicare Advantage and Part D Final Rule

Continuing our series discussing the CY 2023 Medicare Advantage and Part D Final Rule (Final Rule), this post focuses on the D-SNP related provisions under the Final Rule. As we discussed, the Centers for Medicare & Medicaid...more

5/11/2022 / Centers for Medicare & Medicaid Services (CMS) , Durable Medical Equipment , Final Rules , Medicare Advantage , Medicare Part D , Risk Assessment

Final Medicare Advantage and Part D Rule will Likely Require Medicare Advantage Plans to Update 2023 Bids under Maximum...

The Centers for Medicare & Medicaid Services (CMS) released its Final Rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (Final Rule) late last...more

5/5/2022 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicaid , Medicare , Medicare Advantage , Medicare Part D , Out-of-Pocket Expenses , Proposed Rules

OIG Says that Increasing Use of Biosimilars Could Reduce Part D Spending

Last month, the Office of Inspector General for the Department of Health and Human Services (OIG) issued a report finding that Medicare Part D, and Medicare beneficiaries, could reduce spending with increased use of...more

5/3/2022 / Biosimilars , Centers for Medicare & Medicaid Services (CMS) , Food and Drug Administration (FDA) , Medicare Part D , OIG , Out-of-Pocket Expenses

PBM Regulatory Roundup (Spring 2022): The 8th Circuit Rules and More States Issue Regulations

As states move forward with their 2022 legislative sessions in earnest, we have been examining whether the Pharmaceutical Care Management Association (PCMA) v. Wehbi decision has had any initial effects on PBM-focused...more

3/29/2022 / Employee Retirement Income Security Act (ERISA) , Medicare Part D , Pharmacy Benefit Manager (PBM) , Plan Administrators

CMS Proposes Changes to Medicare Advantage Regulations: Network Adequacy, Beneficiary Access, MLR Reporting, and MOOP

Continuing our series analyzing the recently proposed Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs rules (Proposed Rule), this post focuses on a few...more

1/20/2022 / Centers for Medicare & Medicaid Services (CMS) , Medical Loss Ratio , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D , Out-of-Pocket Expenses , Proposed Rules , Public Health Emergency

CMS Proposes New Rules for Medicare Advantage and Part D

Last week, CMS announced proposed rules seeking to increase consumer protections and reduce health care disparities in Medicare Advantage (MA) and Part D, with a strong emphasis on individuals who are dually eligible for...more

1/12/2022 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Durable Medical Equipment , Home Health Care , Medicaid , Medicare Advantage , Medicare Part D , Proposed Rules , Public Health Emergency

GAO Studies Use of PBMs in Medicare Part D

GAO recently released a report analyzing the use of pharmacy benefit managers (“PBMs”) and efforts to manage drug spending and use in the Medicare Part D program. Importantly, the report found that use of PBMs reduced Part D...more

8/27/2019 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , GAO , Medicare , Medicare Part D , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Proposed Rules

CMS Finalizes Medicare Advantage and Part D Drug Pricing Rule

Earlier this month, CMS issued a final rule aimed at lowering drug prices and reducing out-of-pocket expenses in Medicare Advantage and Medicare Part D. This rule is the Administration’s latest effort to address prescription...more

5/29/2019 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Electronic Prescribing , Final Rules , Gag Clauses , Medicare Advantage , Medicare Part D , Out-of-Pocket Expenses , Pharmaceutical Industry , Pharmacies , Pharmacy Benefit Manager (PBM) , Prescription Drugs

CMS Continues to Combat the Opioid Epidemic

Last month, we highlighted a few of the changes CMS proposes in Parts I and II of the Advance Notice and Draft Call Letter. Here, we take a look at CMS’s next steps to combat opioid misuse. CMS says it best in its Fact...more

2/22/2019 / Call Letter , Centers for Medicare & Medicaid Services (CMS) , Drug & Alcohol Abuse , Final Rules , Health Care Providers , Medicare Part D , Opioid , Pain Management , Prescription Drugs

CMS Proposes Changes to Medicare Advantage Program for CY 2020

CMS recently proposed several important changes for the Medicare Advantage ("MA") program that relate to payment, benefit design, and new actions to combat the opioid crisis. These changes, among others, were proposed in...more

2/7/2019 / Advance Notice , Bipartisan Budget Act , Call Letter , Centers for Medicare & Medicaid Services (CMS) , CMMI , Healthcare , Medicare Advantage , Medicare Part D , Opioid , Pharmaceutical Industry , Prescription Drugs , Risk Adjustment Formula

Opioids Have Our Attention

The government is focusing on opioids. Whether it be program policies, enforcement, or legislation, combating the opioid epidemic continues to be a major focus for government officials. It is also a major piece of the...more

6/22/2018 / Alternative Payment Models (APM) , Electronic Medical Records , Health Care Providers , Healthcare Reform , HELP , Legislative Agendas , Legislative Committees , Medicaid , Medicare Part C , Medicare Part D , Opioid , Prescription Drugs , Substance Abuse

CMS Continues to Focus Medicare Plans on Preventing Opioid Abuse

As we highlighted earlier this month, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. These documents are not typically released at the same time,...more

4/23/2018 / Call Letter , Centers for Medicare & Medicaid Services (CMS) , Comprehensive Addiction and Recovery Act of 2016 (CARA) , Drug & Alcohol Abuse , Final Rules , Health Care Providers , Medicare Part D , Opioid , Point of Sale Terminals , Prescription Drugs

CMS’s Advance Notice and Call Letter: How Medicare Plans Can Report, Identify, and Address the Opioid Epidemic

CMS has slowly but surely been providing additional guidance to Medicare Plans (Medicare Advantage and Part D plans) regarding steps they can and should take to address the opioid epidemic as it relates to their...more

3/5/2018 / Advance Notice , Call Letter , Centers for Medicare & Medicaid Services (CMS) , Healthcare , Medicare , Medicare Advantage , Medicare Part D , New Guidance , Opioid , Pharmaceutical Industry , Pharmacies , Prescription Drugs

Proposed Medicare Advantage and Part D Regulations for CY 2019 – CMS Takes on the Opioid Epidemic

Americans today are facing an opioid epidemic that stems in part from the misuse of prescription drugs. CMS takes aim at this crisis in its CY 2019 Medicare Advantage and Part D Proposed Rule (Proposed Rules) by setting out a...more

12/6/2017 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Comprehensive Addiction and Recovery Act of 2016 (CARA) , Drug & Alcohol Abuse , Medicare Advantage , Medicare Part D , Opioid , Pharmaceutical Industry , Prescription Drugs , Proposed Rules

Bridgette Keller

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