Despite a recently implemented rule requiring insurers to disclose what they pay for different kinds of care, patients have yet to benefit. The Centers for Medicare and Medicaid Service (CMS) also requires healthcare systems to do similarly. Unfortunately, a patient advocacy org has […]
Analysts Suggest Impact of Drug Pricing Reforms Would be Limited
Despite a litany of complaints and concerns from the industry, the new US drug pricing reform passed by the Democrats would have a marginal impact on pharma, according to analysts from the Bank of America and UBS. The legislation will allow Medicare to set Part D prices for some medications, 10 by […]
US Government Accountability Office Report on State-Directed Medicaid Payments in Managed Care
The US Government Accountability Office (GAO) released a new report on state-directed payments of Medicaid funds to managed care plans. Earlier this year, Medicaid approved nearly $20 billion in funding in proposals from states looking to direct funding to care providers that meet predetermined […]
Lawmakers Call for Better CMS Oversight of Medicare Advantage Plans
Lawmakers in the US House of Representatives have expressed their concerns over the Center for Medicare and Medicaid Services’ (CMS) oversight of Medicare Advantage due to coverage denials and increased spending. The program has taken up a growing spot in the general Medicare program as of late and, […]
Biogen Ends Aduhelm Study Due to Medicare Restrictions
Biogen has ended its observational ICARE AD real-world data (RWD) trial for Aduhelm, another in a long series of setbacks for the drug. The move was caused in part by the Centers for Medicaid and Medicare Services’ (CMS) decision to only cover the drug for patients in clinical trials. The ICARE AD […]
US Supreme Court Won’t Hear UnitedHealth’s Medicare Advantage Lawsuit
UnitedHealth was handed a major setback Tuesday, June 21st, when the US Supreme Court declined to hear its lawsuit over the Medicare Advantage overpayment rule. The Centers for Medicare and Medicaid Services (CMS) established the overpayments rule in 2014, which mandates that MA plans must return […]
Politico: CMS Wasn’t Built for a Pandemic
Despite mandating infection-control measures in hospitals, the Centers for Medicare and Medicaid Services (CMS) haven’t been able to enforce them. As a result, hospitals have been able to lessen anti-COVID measures despite a growing surge in nosocomial cases. For example, over a third of nurses at […]
NASP Supports Biden Administration’s Rx Drug Cost-cutting Measures for Seniors but Seeks Protections for Pharmacies
Sheila Arquette, RPh, CEO and President of the National Association of Specialty Pharmacy (NASP), has praised efforts by the Biden administration and Centers for Medicare and Medicaid Services (CMS) to reduce the high out-of-pocket drug costs seniors face. However, she and the NASP call for CMS to […]
Webinar: CEVR’s Virtual Annual Methods, Policy, and Data Symposium
On Wednesday, April 6th, the Center for the Evaluation of Value and Risk in Healthcare (CEVR) will host its virtual Annual Methods, Policy, and Data Symposium. The CEVR, a project of the Tufts Medical Center’s Institute for Clinical Research and Health Policy Studies, was founded in 2006 with the […]
CMS Announces Drug Payment Reductions with the “Most Favored Nation” Effective January 1, 2021
Centers for Medicare and Medicaid Services (CMS) announced the long-awaited seven year Most Favored Nation (MFN) model as an interim final rule. Published in the Federal Register on Nov. 27, the rule will potentially decrease payment for 50 expensive drugs provided in hospital outpatient departments […]
