News & Analysis as of

Medicare Part D

Increased Scrutiny of Patient Assistance Programs: Enforcement Overview and Considerations

by K&L Gates LLP on

In the midst of ongoing national debates regarding drug pricing [1] and access to innovative therapies, patient assistance programs (“PAPs”) are facing an evolving legal landscape, as well as increased enforcement scrutiny...more

Capitol Hill Healthcare Update

by BakerHostetler on

CONGRESS WORKS TO PASS BUDGET BEFORE FRIDAY’S SHUTDOWN DEADLINE - House leaders are pushing to schedule a vote this week on a $1.3 trillion budget agreement that would give the Senate enough time to pass it before a Friday...more

Capitol Hill Healthcare Update

by BakerHostetler on

HOUSE VOTE SET FOR UPDATED ‘RIGHT-TO-TRY’ LEGISLATION - The House will vote Tuesday on updated but still controversial legislation that would give terminally ill patients wider access to prescription drugs that haven’t won...more

Capitol Hill Healthcare Update

by BakerHostetler on

CONGRESS SCRAMBLES TO COMPLETE BUDGET IN ADVANCE OF DEADLINE - Lawmakers are working overtime – including on key healthcare issues – to wrap up work on a $1.2 trillion omnibus budget bill that would fund the government for...more

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

CMS Releases Proposed 2019 Medicare Advantage/Part D Reimbursement Methodologies and Policies

by Reed Smith on

CMS is seeking comments on its proposed updates to the methodologies used to pay Medicare Advantage (MA) and Part D plan sponsors for 2019. This year CMS released its 2019 Advance Notice and Draft Call Letter in two parts. ...more

The President’s Budget and Shifting Policy on Prescription Drugs

On February 12, the Trump administration released the President’s Budget (or “the Budget”), outlining spending priorities for FY 2019. The Budget—though an important annual milestone and barometer of the administration’s...more

Health Update - February 2018

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

Key Health Care Provisions of Bipartisan Budget Act of 2018

by Baker Donelson on

The wide-reaching Bipartisan Budget Act of 2018 (BBA), passed by Congress and signed by the President on February 9, 2018, extends and modifies dozens of health care programs, including extending funding for two years for...more

President's Budget on Health Care: Entitlement Reform, Opioid Funding, and Cuts to Health Programs

by Baker Donelson on

Note: All fiscal estimates cited over a ten-year budget window refer to the Fiscal Year 2019-2028 budget window. The President's fiscal year 2019 (FY19) budget proposal for the Department of Health and Human Services (HHS)...more

Trump Administration Fiscal Year (FY) 2019 Budget and Healthcare Programs

by Holland & Knight LLP on

The Trump Administration on Feb. 12 released its Fiscal Year (FY) 2019 budget request, titled "An American Budget." Unlike last year's budget, which was released in late May, the release of this budget conforms to the typical...more

Bipartisan Budget Act of 2018 Enacts Changes to Employee Retirement and Health Benefit Plans, and Medicare

by Ballard Spahr LLP on

Following a brief shutdown of the federal government, on February 9, Congress passed and President Donald J. Trump signed into law the Bipartisan Budget Act of 2018 (Budget Act), which provides Congress until March 23 to...more

The Bipartisan Budget Act Boosts Medicare: Flexibility and Financing for Healthcare Plans and Providers

On Friday, February 9, 2018, President Trump signed the Bipartisan Budget Act of 2018 (the “Budget”), a two-year budget which, in significant part, made substantial revisions to Medicare, including the Medicare Advantage (MA)...more

2019 White House and HHS Budgets Released: Key Changes to Drug Pricing and Reimbursement Proposed

by Hogan Lovells on

On February 12, 2018, the White House Office of Management and Budget released an overview of the president's Fiscal Year (FY) 2019 Budget (the Budget), which makes, among many others, several proposals regarding drug pricing...more

New Funding Legislation’s Impact on Health Care Programs

by Foley & Lardner LLP on

Congress passed a funding bill early this morning just after the February 8th deadline. The new legislation will make several changes to the Medicare program, delay cuts to disproportionate share hospitals, provide two years...more

White House Unveils Proposal on Drug Pricing

by Holland & Knight LLP on

On Feb. 9, 2018, the Trump Administration released a 30-page report analyzing domestic and global factors influencing drug pricing. The report by the Council of Economic Advisers (CEA) is expected to inform the HHS' Fiscal...more

Blog: Drug Costs Targeted in Administration’s Fiscal Year 2019 Budget

by Cooley LLP on

Yesterday, the Administration released its Fiscal Year 2019 (FY19) Budget blueprint. The $4.4 trillion Budget blueprint includes several proposals directed at lowering the cost of prescription drugs. These proposals are...more

CMS Considers 7-Day Limit on Initial Opioid Prescriptions under Part D

In a Draft Call Letter issued February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) announced that it is considering a number of new strategies to address opioid overutilization within the Medicare Part D...more

Bipartisan Budget Act of 2018: Major Impacts on Health Care

by Baker Donelson on

After a brief federal government shutdown overnight, Congress passed and the President signed into law the Bipartisan Budget Act of 2018 on February 9, 2018. The Senate voted 71-28 and the House voted 240-186 to approve the...more

CMS Encourages Innovation in MA, Asks Part D Plans to Combat Opioid Overuse, and Fine-Tunes Payments

by McDermott Will & Emery on

The Centers for Medicare & Medicaid Services (CMS) has released its annual payment and policy guidance for Medicare Advantage and Part D plans. CMS is continuing to find ways to inject more flexibility into these programs,...more

CMS Releases Advance Notice and Call Letter for Medicare Advantage and Part D

Late last week, CMS released the Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 draft Call Letter (Advance Notice...more

OIG January 2018 Work Plan Update

by Baker Ober Health Law on

The OIG added six new items to its Work Plan with the January 2018 update, as listed in the chart below. Consistent with prior Work Plan missives, the OIG continues to focus its efforts on reducing prescription opioid misuse....more

Capitol Hill Healthcare Update

by BakerHostetler on

Congress is expected this week to approve a fifth stopgap budget bill to keep the government open in advance of a Thursday shutdown deadline, and key healthcare provisions could be included in the budget package. If...more

Window on Washington - Vol. 2, Issue 5

by Clark Hill PLC on

Another Shutdown? Congress needs to pass another short-term spending bill by Friday in order to keep the government open, but some House Republicans are against the plan for a fifth continuing resolution that would fund the...more

Trends in Medicare Part D Benefit Design and Cost Sharing for Adult Vaccines, 2015–2017

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

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