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Medicare

April 16, 2004 | Daily News

State prescription drug programs will be able to use their ability to supplement the new Medicare drug benefit to encourage competing drug plans to provide steeper drug discounts, more open drug formularies and less restrictive pharmacy networks, the head of one state plan told Inside CMS.

April 15, 2004 | Daily News

The national association representing chain drug stores is pushing the Federal Trade Commission (FTC) officials to launch a broader investigation into the possible conflicts of interests of pharmacy benefit managers (PBMs) that operate mail-order pharmacies. The National Association of Chain Drug Stores (NACDS) says a newly launched FTC study -- mandated under last year's Medicare prescription drug act -- needs to look at a wide array of payments received by PBMs that boost the cost of drug coverage to health plans.

April 14, 2004 | Daily News

CMS' decision to withdraw a controversial policy bulletin on coverage criteria for power wheelchairs leaves unanswered exactly what standard the agency will use to determine if the device is warranted, providers say.

In a recent open door forum with providers and beneficiary groups, CMS officials said there was "no bright line" they could provide for when Medicare will cover the devices.

April 14, 2004 | Daily News

HHS is asking its drug importation task force to consider if the government should allow unapproved foreign drugs to be legally sold in this country, according to a new list of more specific and controversial questions HHS has asked the panel to tackle. However, panel members today (April 14) seemed skeptical of the idea and FDA reportedly is concerned about legislation that would allow for such imports.

April 14, 2004 | Daily News

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CMS' controversial proposal to pre-approve states' Medicaid budgets before sending them federal matching funds will not be implemented for states' fiscal year (FY) 2005 budgets, according to a state official tapped by the agency to chair a task force on the plan.

April 13, 2004 | Daily News

The American Medical Association's (AMA) coding panel has set up a workgroup of physicians and CMS officials to prepare recommendations by this August for coding changes for administering drugs under part B, as oncologists have begun lobbying for changes that will increase reimbursement for chemotherapy and ancillary services.

April 13, 2004 | Daily News

CMS will exclude off-label uses of drugs and drugs that do not provide results as good or better than treatments currently covered by Medicare under a much-anticipated demonstration program the agency now says will be implemented this summer, well past the March 7 deadline set by the Medicare Modernization Act (MMA).

April 09, 2004 | Daily News

CMS is considering paying a supplying fee for pharmacies that provide immunosuppressant drugs for transplant patients after specialty pharmacies and their congressional supporters made the case that last year's Medicare law cut reimbursement rates below acquisition costs.

April 08, 2004 | Daily News

The Senate Finance Committee yesterday (April 7) began consideration of a Bush administration proposal to move more elderly and disabled Medicaid beneficiaries from institutional care facilities to home- and community-based care, but did not outline a legislative agenda to implement the policy change.

April 07, 2004 | Daily News

Senate Finance Committee chair Charles Grassley (R-IA) and Rep. Henry Waxman (D-CA) are urging HHS to collect and make public information on how much nursing homes rely on care provided by feeding assistants instead of nurses and other skilled personnel so that family members can make informed decisions about individual facilities.

The data should be displayed on the Nursing Home Compare website now operated by HHS, the lawmakers said in an April 7 letter to HHS Secretary Tommy Thompson.

April 05, 2004 | Daily News

The Federal Trade Commission is urging a federal appeals court to overturn a lower court ruling that blocks Teva from marketing its generic Zoloft due to a settlement agreement between Zoloft producer Pfizer and the generic drug company Ivax. FTC says the district court decision, if allowed to stand, would allow a brand-name drug firm to collude with the first generic drug applicant to thwart generic drug competition.

April 02, 2004 | Daily News

CMS will give lawmakers a proposal next week to cut over $20 billion in federal Medicaid funds by prohibiting states from overpaying providers and "recycling" the excess funds back into their treasuries, according to CMS Medicaid Director Dennis Smith.

April 01, 2004 | Daily News

In a party-line vote, Republicans April 1 rejected a Democratic effort to get the House Ways and Means Committee to subpoena former CMS Administrator Tom Scully and White House health policy advisor Doug Badger after the two officials declined to testify in an ongoing probe into the alleged withholding of the CMS actuary's higher cost estimates of the Medicare prescription drug bill.

March 31, 2004 | Daily News

CMS pitched state Medicaid directors today (March 31) on its pending proposal to pre-approve state Medicaid budgets before releasing federal funds, even as Democratic congressional health policy leaders are demanding that HHS Secretary Tommy Thompson withdraw the plan.

Dennis Smith, CMS's Medicaid chief, acknowledged some resistance to the plan from state Medicaid directors, but told Inside CMS that he would take the opportunity to sell them on the merits of the proposal.

March 31, 2004 | Daily News

A request by AstraZeneca that Medicare cease reimbursement for alleged knock-offs of one of its anti-asthma products has been kicked up to the HHS secretary's office after CMS rebuffed the drug manufacturer.

March 31, 2004 | Daily News

Seniors will be able to compare prices of competing brand-name drugs -- such as cholesterol reducing drugs -- as well as generic equivalents by using a Web site CMS will establish for the drug discount cards next month and will likely keep in place after the drug benefit kicks off in 2006, senior administration officials said today.

HHS Secretary Tommy Thompson touted the Web site as a mechanism to inject transparency and competition in drug pricing that could have an impact beyond the Medicare beneficiaries eligible for the discount cards.

March 30, 2004 | Daily News

Many private health plans are looking forward to filling a new Medicare Advantage role that focuses on serving "special needs individuals" such as nursing home residents and Medicaid-eligible beneficiaries.

A spokesperson for America's Health Insurance Plans (AHIP) said that many of its members are interested in the new opportunity presented by the Medicare Modernization Act (MMA).

In an audio conference hosted by AHIP this month, a Wall Street analyst said that the new MA plans will help make specialized care programs a big growth sector in coming years.

March 30, 2004 | Daily News

Pharmacies that serve long-term care facilities want CMS to consider a variety of policy options for how the new Medicare drug plans will treat nursing home residents, including special drug plans dedicated to this vulnerable population or special rules for reimbursement and formularies.

March 30, 2004 | Daily News

House Democrats have asked former CMS Administrator Tom Scully and other top White House and CMS officials to testify this week on the suppression of higher CMS cost estimates in the run-up to last year's vote on the Medicare drug benefit, as Senate Democrats turned their focus on President Bush in the latest turn to the lingering scandal.

March 26, 2004 | Daily News

CMS yesterday (March 25) approved a list of 28 prescription drug discount card sponsors that is weighted heavily towards national cards sponsored by large pharmacy benefit managers (PBMs), after rejecting over half the applications to sponsor cards available to all Medicare beneficiaries. The agency also gave the green light to 43 cards that Medicare Advantage HMOs will offer exclusively to their members.

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