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Medicare

August 11, 2004 | Daily News

The Biotechnology Industry Organization is worried that an upcoming clinical effectiveness study mandated by the Medicare Modernization Act will hurt the biotechnology industry, and BIO is urging the government not to use the study for coverage decisions. BIO contends that the study must account for the broader benefit of covering biologics and not simply compare the effectiveness of biotech products to often lower-priced conventional drugs.

August 11, 2004 | Daily News

CMS wants to require fallback drug plans to meet a target for drug manufacturer price discounts in order to receive incentive payments, according to the proposed Medicare drug benefit rule issued late last month, arguing the incentives do not mean the agency is violating the prohibition against interference in negotiations on drug prices.

August 10, 2004 | Daily News

Charging that CMS is effectively fixing the fees that medical directors can negotiate with dialysis facilities by announcing what types and levels of payments are safe from legal scrutiny, nephrologists will seek legislative relief fix to counter this provision of the so-called "Stark II rule."

August 10, 2004 | Daily News

A new survey suggests Democrats may get a boost at the polls this November from Medicare beneficiaries who do not favor Medicare's new prescription drug benefit. The poll has immediately attracted criticism from defenders of the landmark law.

Released today (Aug. 10), the poll states that 28 percent of 1,223 beneficiaries surveyed said the Medicare law will affect their presidential vote, with more people saying it makes them more likely to vote for Democrat contender John Kerry than President Bush.

August 09, 2004 | Daily News

While the Medicare Modernization Act proposed to extend coverage of an expensive biological therapy to the home setting, CMS' subsequent stance that equipment to administer it is unnecessary is rendering the benefit next to useless, advocates say.

Intravenous immune globulin (IVIG) is used to treat persons with serious immune deficiencies. It has been covered in physician offices and in infusion centers, and as of Jan. 1 in the home.

August 09, 2004 | Daily News

The American Medical Association's (AMA) CPT Editorial Panel may decide this week whether to accept a specialists workgroup's call for changes to the drug administration codes that focus primarily on increasing payments for toxic or complex nonchemotherapy administrations or capturing all the support services oncology practices provide chemotherapy patients.

The panel meets Aug. 12-14 in private in Denver and should make its decisions on coding changes during that meeting or very shortly afterward, an AMA source told Inside CMS.

August 06, 2004 | Daily News

A coalition working to boost enrollment in Medicare's $600 drug card subsidy is again lobbying CMS to automatically enroll certain low-income beneficiaries -- this time armed with an analysis asserting CMS has the legal authority, according to informed sources.

August 06, 2004 | Daily News

CMS' proposed drug rule has done little to allay state concerns that the benefit's clawback calculation may not accurately reflect all 2003 drug rebates, a scenario that would leave states paying out more money to the federal government.

CMS' July 26 regulation signals no solution to the states' key concern that not all 2003 rebates will be paid by drug manufacturers in time for the clawback calculation. The drug benefit gradually transfers the drug costs of dual eligibles from Medicaid to Medicare but claws back most of the savings.

August 05, 2004 | Daily News

The Medicare drug benefit implementation blueprint issued by CMS last week appears to give some low-income residents in a handful of states back-door access to federal help with their drug costs even if they officially fail to qualify for the financial aid.

August 05, 2004 | Daily News

CMS' proposed roadmap for Medicare's new prescription drug benefit suggests prescription drug plans may have to meet electronic prescribing standards as early as 2006 -- three years faster than originally specified.

CMS included language in its proposed drug rule, issued July 26, requiring plans to be able to support final CMS e-prescribing standards -- including those established before the drug benefit takes effect in 2006. CMS says it intends to mandate a "starter set of well-established standards" by the time drug coverage begins.

August 04, 2004 | Daily News

Pharmacy Plus drug coverage programs will not be allowed to fill in the gap in coverage in the part D prescription drug benefit and the four states currently running them should therefore direct their Pharmacy Plus spending toward state pharmaceutical assistance programs (SPAPs) which can do so, CMS says in its newly proposed rule for the January 2006 drug benefit.

August 04, 2004 | Daily News

CMS actuaries have added $30 billion to their five-year projected cost for private Medicare plans and hiked estimates of per-capital drug expenditures by $11 billion as part of revised estimates included in the mid-session budget review released by the Office of Management and Budget (OMB) this week.

August 03, 2004 | Daily News

CMS will soften the blow to hospitals facing lower Medicare payments next year because of redrawn labor market boundaries, according to the final inpatient rule issued yesterday (Aug. 2).

August 03, 2004 | Daily News

Facing widespread opposition from hospitals and pressure from Capitol Hill, CMS has backed off a proposal to curtail admissions to long-term care hospitals from the host hospitals where they are located, deciding on a four-year phase-in that would ultimately set more flexible restrictions on admissions to hospital-in-hospitals.

August 02, 2004 | Daily News

In an effort to maximize the number of employers that retain retiree drug coverage and opt to receive a tax-free subsidy for drug costs, CMS is considering a series of options that give employers greater ability to shift premium costs onto retirees.

August 02, 2004 | Daily News

The process to develop model guidelines for the new Medicare drug benefit is coming under fire for a lack of transparency from a range of stakeholders, including those handpicked to serve on advisory forums, despite recent efforts by U.S. Pharmacopeia (USP) to make public the process it has conducted behind closed doors since early May. USP officials defend the process, pointing to an upcoming opportunity for public comment after the draft guidelines are released next month.

July 30, 2004 | Daily News

Nursing homes will receive a full 2.8 percent market basket increase for next year's Medicare reimbursements and will retain temporary add-on payments pending long-promised reforms to their payment classifications. The fiscal year (FY) 2005 fee schedule for skilled nursing facilities (SNFs) issued today (July 30) is estimated to increase provider payments $440 million.

July 30, 2004 | Daily News

A major Florida homecare company is threatening to drop its Medicare lung disease patients on the eve of the presidential election, after CMS issued a proposed rule slashing payments for inhalation drugs and indicating any compensatory fee would be limited and of short duration.

Lincare Holdings Inc. said its decision to continue to serve patients with chronic obstructive pulmonary disease hinges on the adequacy of the dispensing fee CMS sets to make up for cuts of about 90 percent in the reimbursement for drugs dispensed through nebulizers.

July 29, 2004 | Daily News

The proposed Medicare physician rule issued this week includes a supplying fee for immunosuppressive, anti-cancer and anti-emetic drugs set at less than a quarter of the level sought by specialty pharmacies.

July 29, 2004 | Daily News

Physicians will see their Medicare reimbursements for drugs reduced next year, but the cuts can be significantly mitigated if CMS updates its codes for administering drugs and biologicals, according to the proposed 2005 physician fee schedule rule issued Tuesday (July 27). The proposed rule calls for some steep reductions in drug reimbursements due to the new average sales price (ASP) payment rate mandated by the Medicare Modernization Act (MMA).

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