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Medicare

May 18, 2018 | Daily News

Medicare beneficiary advocates allege CMS' draft “Medicare & You” handbook for 2019 distorts the facts surrounding traditional Medicare and Medicare Advantage by suggesting MA is the cheaper option, describing MA prior authorization as a “right,” and failing to note traditional Medicare's broader provider network.

May 18, 2018 | Daily News

Durable medical equipment and oxygen lobbyists say CMS' recent move to raise Medicare reimbursement for DME in the second half of 2018 offers much needed relief for rural areas, but they are upset the interim final rule didn't extend that pay raise to other non-competitive bid areas, aside from Hawaii and Alaska.

May 18, 2018 | Daily News

CMS is writing another Part D rule, according to the unified agenda that outlines agency rulemaking plans, and Ross Margulies, an associate at Foley Hoag, expects that many of the president’s proposals to curb drug prices will be included in that rule.

May 17, 2018 | Daily News

CMS officially put drug plans on notice to stop using so-called gag orders that prohibit pharmacists from telling customers when it is more expensive to use insurance to buy drugs.

May 17, 2018 | Daily News

CMS' Medicare Evidence Development & Coverage Advisory Committee will meet in August to consider a National Coverage Determination for chimeric antigen receptor (CAR)-T cell therapies after UnitedHealthcare requested such a determination to make sure there is a level playing field across Medicare for coverage of the expensive therapies.

May 17, 2018 | Daily News

Specialists with a big stake in Part B warn HHS that following through with the administration’s proposal to let Part D plans negotiate Part B drug prices would cause patients to face access restrictions in Part D that they don’t have to deal with in Part B.

May 17, 2018 | Daily News

The House Ways & Means Committee approved Wednesday (May 16) six relatively uncontroversial and bipartisan bills aimed at reducing opioid abuse in Medicare.

May 16, 2018 | Daily News

HHS Secretary Alex Azar is explaining why the president’s newly released drug pricing plan doesn’t deliver on two of President Donald Trump’s campaign promises: direct drug price negotiation in Medicare and allowing importation of cheaper drugs from Canada.

May 16, 2018 | Daily News

HHS Secretary Alex Azar on Wednesday (May 16) hit back at the drug industry for criticizing the administration’s proposal to move Medicare Part B drugs into Part D, and he said the announcement on how HHS will execute that policy is coming soon.

May 16, 2018 | Daily News

HHS is weighing two opposing approaches for dealing with Medicare drug rebates -- doing away with rebates or making plans share them at the pharmacy counter -- and HHS Secretary Alex Azar seems to be leaning toward the former, which drug makers do not like.

May 16, 2018 | Daily News

A Pharmaceutical Research and Manufacturers of America executive on Tuesday (May 15) criticized several policies that HHS is considering to lower drug costs: moving Medicare Part B drugs to Part D, replacing the Part B doctor-reimbursement system with the Competitive Acquisition Program, encouraging plans to restrict the use of drugs in protected classes, removing the two-drug per-class rule in Part D, basing Medicaid’s average manufacturer price calculation on commercial-market net prices and removing the cap on price-inflation penalty in Medicaid.

May 14, 2018 | Daily News

HHS Secretary Alex Azar said CMS will take a more permissive approach to the performance scores it gives drug plans that use medication management tools for drugs in Part D’s six protected classes.

May 14, 2018 | Daily News

FDA soon will announce a set of reforms intended to make the new drug approval process more efficient and spur innovation, FDA Commissioner Scott Gottlieb told reporters during a Monday (May 14) media briefing.

May 14, 2018 | Daily News

HHS Secretary Alex Azar said Monday (May 14) that HHS’ proposal to subject Part B drugs to price negotiations in Part D is the most important piece of the president’s plan to contain drug costs.

May 11, 2018 | Daily News

Many of the policies in the president’s drug price plan put the onus on patients to get cheaper drugs: such as including prices in drug ads, giving patients information on competing drug prices during office visits, posting drug prices on Medicare’s “dashboard” website and banning gag orders that stop pharmacists from telling customers when it is cheaper to buy drugs without insurance.

May 10, 2018 | Daily News

The president’s plan for lowering drug costs includes four strategies that senior administration officials say can be done without congressional help: Stop drug makers from gaming rules to thwart generic and biosimilar competition; remove government rules that prevent health plans from negotiating better deals, especially on expensive drugs; create incentives to lower drug list prices; and lower beneficiaries’ out-of-pocket spending.

May 10, 2018 | Daily News

HHS Secretary Alex Azar said Thursday (May 10) that he plans to ask the department’s Inspector General to investigate price concessions that pharmacy benefit managers retroactively charge pharmacies.

May 10, 2018 | Daily News

Although brand drug makers are now lobbying to make plans share rebates with seniors at the point of sale, the drug industry in 2014 argued against any government interference in the business dealings among drug makers, plans and pharmacies, and sources say the drug industry has gotten away with changing its tune.

May 09, 2018 | Daily News

CMS on Wednesday (May 9) released an interim final rule that will increase pay for durable medical equipment provided in rural and other areas not covered by the competitive bidding program from June through the end of the year, and the agency says more rules are planned on rates for DME and enteral nutrition in 2019 and beyond.

May 09, 2018 | Daily News

Brand drug lobbyists are worried the president’s plan to lower drug costs, which will be announced Friday, might include a measure to set prices at levels paid in other countries.

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