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Medicare

May 21, 2019 | Daily News

A coalition of provider and patient groups are urging CMS to rethink its plan to include noninvasive ventilators in the durable medical equipment competitive bidding program, as DME suppliers simultaneously are gathering support for a congressional sign-on letter with the same request.

May 21, 2019 | Daily News

A Commonwealth Fund analysis released Thursday (May 16) calls for the use of a common provider directory format via machine-readable application programming interface (API) technology and said CMS, plans and states should be encouraged to leverage such technology to improve the accuracy of directories.

May 20, 2019 | Daily News

Several lobbyists on Monday suggested the Senate health committee could unveil a discussion draft of policy proposals to lower health care costs as soon as Thursday (May 23).

May 20, 2019 | Daily News

Melanie Bella, the founding director of the Medicare-Medicaid Coordination Office at CMS, was named on Monday (May 20) as the new chair of the congressional Medicaid advisory commission, and two new members -- health care lawyer Tom Barker and Georgetown University professor Tricia Brooks -- were appointed to the commission.

May 17, 2019 | Daily News

The House Energy & Commerce Committee will consider seven pieces of drug-pricing transparency legislation at a hearing on May 21, the committee announced Friday (May 17).

May 17, 2019 | Daily News

CMS delayed, without explanation, the national Medicare coverage policy for new expensive hospital-administered cancer drugs that was due to be published Friday (May 17).

May 16, 2019 | Daily News

Senate committee leaders are looking to include surprise billing legislation and several drug-pricing bills in an upcoming health care cost-reduction package.

May 16, 2019 | Daily News

Two consecutive administrations have failed to follow through with proposals to weaken Medicare Part D coverage protections in six drug classes.

May 16, 2019 | Daily News

The Trump administration did not follow through on an informal proposal to make pharmacy benefit managers subtract pharmacy concessions from the prices that seniors pay for drugs when they pick up their prescriptions.

May 16, 2019 | Daily News

Senate Finance Committee ranking Democrat Ron Wyden (OR) introduced a bill Wednesday (May 15) that would require traditional Medicare, Medicare Advantage (MA) plans, Medicare Part D plans and insurance companies to provide information to individual enrollees about the costs, including out-of-pocket costs, of services and prescription drugs via online tools.

May 16, 2019 | Daily News

A bipartisan group of senators that has been working on a plan to curb surprise billing released legislation Thursday (May 16) that calls for a baseball-style arbitration process for settling disputes between providers and insurers -- a process opposed by the White House and not included in the recently released House draft legislation.

May 15, 2019 | Daily News

A key industry standard-setting group paved the way for wholesalers and other third-party entities to compete with pharmacy benefit managers for a new role in the Trump administration’s proposed rebate system in Part D and Medicaid managed care.

May 15, 2019 | Daily News

Pharmacy benefit managers often don't favor drugs with lower list prices, even when the discounted (net) price equals that of an identical drug with a higher list price, because patients pay more to insurers for the high-list-price drug, and that bigger patient cost sharing amount is factored into net prices used to gain placement on formularies, an Amgen executive told House Energy & Commerce health subcommittee members Thursday (May 9).

May 14, 2019 | Daily News

The House Energy & Commerce Committee released a draft bipartisan proposal to tackle surprise medical billing that ties a benchmark payment rate for out-of-network services to the average in-network rate for that geographic area -- a move opposed by hospitals and providers, who don’t like rate setting.

May 13, 2019 | Daily News

Progressive Democrats have made clear they do not want an arbiter to mediate disputes between drug makers and Medicare over drug prices, but their opposition to arbitration goes beyond the pharmaceutical space.

May 13, 2019 | Daily News

The pilot CMS is using to artificially lower Medicare Advantage and drug-plan premiums next year will not apply to group MA plans, which means that 4.3 million retired union workers and state and local government employees could be hit with drastically higher premiums if HHS follows through on its proposal to ban drug rebates that aren’t shared at the point of sale.

May 10, 2019 | Daily News

Rep. Joe Courtney (D-CT) expressed optimism Thursday (May 9) that the Democrats’ takeover of the House could improve the chances for a bill he has introduced across multiple sessions that would count beneficiaries’ time spent under observation toward the three-day hospital stay required before Medicare covers nursing home care.

May 10, 2019 | Daily News

A study released Thursday (May 9) by the Rand Corporation says many hospitals across 25 states charge private insurers double or triple the rate that Medicare pays for the same services and the researchers called on insurers to use Medicare payment rates as a benchmark, a proposal hospital groups slammed, saying it would jeopardize hospital resources.

May 09, 2019 | Daily News

President Donald Trump said Thursday (May 9) that his administration would allow prescription drug importation from foreign countries if the programs would create significant cost savings.

May 09, 2019 | Daily News

The American Hospital Association is praising legislation it says would undo cuts to Medicare pay for clinic visits at certain facilities exempted from site-neutral policy in the Bipartisan Budget Act of 2015 -- cuts that AHA is separately seeking to overturn through the federal courts.

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