Lauren Moldawer on Medicare Part D

Mintz IRA Update — The Consequences and Costs of Redesigning the Part D Program

The passage of the Inflation Reduction Act of 2022 (IRA) marked a significant milestone in Congress’s ongoing efforts to address escalating health care costs. While the IRA aims to rein in government spending on Medicare and...more

7/16/2024 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Health Insurance , Health Plan Sponsors , Inflation Reduction Act (IRA) , Manufacturers , Medicare Part D , Out-of-Pocket Expenses , Reimbursements

Unpacking CMS’s 2025 DSNP Changes: Considerations for Medicare Advantage Organizations

As part of its 2025 Medicare Advantage and Part D Final Rule (the Final Rule), the Centers for Medicare & Medicaid Services (CMS) made a number of enrollment changes impacting dual eligible special needs plans (DSNPs). The...more

5/3/2024 / Centers for Medicare & Medicaid Services (CMS) , Enrollment , Final Rules , Medicaid , Medicare Advantage , Medicare Advantage Organizations (MAOs) , Medicare Part D

CMS Releases Part Two of Guidance for the Inflation Reduction Act’s Medicare Prescription Payment Plan

On February 15, 2024, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Prescription Payment Plan Draft Part Two Guidance (Part Two Guidance) as part of the Inflation Reduction Act’s (IRA) efforts to...more

2/27/2024 / Centers for Medicare & Medicaid Services (CMS) , Inflation Reduction Act (IRA) , Medicare Part D , Out-of-Pocket Expenses

CMS Releases Draft Part One Guidance on the Maximum Monthly Cap on Cost-Sharing Payments Program to Part D Plans

Most of the recent focus around the implementation of the Inflation Reduction Act (IRA) by the press and the industry has been on the Medicare Drug Price Negotiation Program and its potential impact on manufacturers. But the...more

9/8/2023 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Cost-Sharing , Drug Pricing , Inflation Reduction Act (IRA) , Medicare Part D , Negotiations

CMS Announces Drug List for Inflation Reduction Act Price Negotiations

Today, the Centers for Medicare & Medicaid Services (CMS) released the first 10 drugs (“Listed Drugs”) that will be included in the Inflation Reduction Act’s Medicare Drug Price Negotiation Program (“Negotiation Program”)....more

8/31/2023 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Fair Price , Inflation Reduction Act (IRA) , Medicare , Medicare Part D , Negotiations , Prescription Drugs

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

Medicaid Best Price 101: A Review of Medicaid Best Price Policy and New CMS Guidance on Medicaid Best Price Reporting for Value...

At the end of March 2022, the Centers for Medicare & Medicaid Services (CMS) released guidance to drug manufacturers and states on reporting Medicaid Best Price under value based purchasing (VBP) arrangements (Medicaid Best...more

4/27/2022 / Centers for Medicare & Medicaid Services (CMS) , Department of Veterans Affairs , Final Rules , Medicaid , Medicaid Drug Rebate Program , Medicare Coverage Gap Discount Program , Medicare Part D , New Guidance , Section 340B , Value-Based Purchasing

Biden Administration’s Drug Pricing Plan Calls for Bold Action by Congress

It’s finally here – the Drug Pricing Plan that President Biden ordered the Department of Health and Human Services (HHS) to produce by the end of August (the “Plan”) was released publicly by the Administration on September 9,...more

9/13/2021 / Biden Administration , Biosimilars Action Plan (BAP) , BPCIA , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , Executive Orders , Food and Drug Administration (FDA) , Medicaid Drug Rebate Program , Medicare Part B , Medicare Part D , MedPAC , Pharmaceutical Industry , Prescription Drugs

The OIG Urges CMS to Implement Solutions to Reduce Fraud in Medicare Part C and Part D

Recently, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its 2019 “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations.” The OIG...more

8/5/2019 / Annual Reports , Department of Health and Human Services (HHS) , Fraud Abuse and Waste , Information Reports , Medicare , Medicare Advantage , Medicare Part C , Medicare Part D , OIG , Reporting Requirements

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

The OIG Identifies “Significant Vulnerabilities” in the Medicare Hospice Program: What This Might Mean for Hospice Providers?

Last week, the Department of Health and Human Services – Office of Inspector General (“OIG”) released a portfolio report identifying multiple vulnerabilities in the Medicare Hospice Program (the “Hospice Portfolio Report”),...more

8/9/2018 / Centers for Medicare & Medicaid Services (CMS) , Government Investigations , Health Care Providers , Hospice , Inpatient Billing , Medicare , Medicare Part D , OIG , Physician Medicare Reimbursements , Skilled Nursing Facility

Lauren Moldawer

Mintz

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