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Medicare

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.

March 26, 2004 | Daily News

Medtronic will file a formal request within a month for wider Medicare coverage of its implantable cardioverter defibrillator following completion of a study that purports to show millions of heart failure victims could lead longer lives if outfitted with the expensive device, according to a company spokesperson.

CMS Medical Director Sean Tunis plans to meet with the study's statisticians within a month and expects the agency will be able to process the coverage request before the statutory nine-month deadline kicks in, according to a CMS spokesperson.

March 26, 2004 | Daily News

CMS has given itself room for interpretation on which boutique hospitals it may exempt from a congressionally mandated moratorium on physicians' ability to refer Medicare patients to specialty hospitals in which they have a financial stake.

March 26, 2004 | Daily News

CMS will require contractors for its upcoming chronic care pilot program to have a well-developed plan for how they intend to engage and communicate with physicians, according to the CMS official in charge of the pilot.

March 26, 2004 | Daily News

CMS today (March 26) announced that Medicare Advantage HMOs would receive a minimum 6.6 percent rate increase in 2005, based on preliminary data. The agency also took two other steps that had the effect of boosting plan rates.

March 25, 2004 | Daily News

HHS Secretary Tommy Thompson said the White House did not pressure the chief CMS actuary to withhold cost estimates on last year's Medicare drug bill, predicting a probe by the HHS Office of Inspector General would focus on one incident involving an alleged threat from former CMS Administrator Tom Scully.

March 25, 2004 | Daily News

The CMS chief actuary revealed yesterday (March 24) he told the White House in early June that he projected the pending Medicare prescription drug legislation would exceed the $400 billion spending target by some $150 billion.

March 24, 2004 | Daily News

The $58 million that FDA's soon-to-be top official told lawmakers it would cost to set up a Canadian drug reimportation program was taken from an old forecast the agency helped make while offering technical assistance to Rep. Gil Gutknecht (R-MN) when he was writing reimportation legislation years ago, according to an FDA source. Even then agency officials estimated that a reimportation program would cost about $100 million once it was up and running, but the source says that figure likely does not come close to what it would cost now that more drugs are coming across the border.

March 24, 2004 | Daily News

Higher payments to rural hospitals and private plans under last year's Medicare reforms are a major factor in the accelerated depletion of the Medicare trust fund, which trustees this week predicted would empty its reserves by 2019, seven years earlier than last year's prediction.

March 23, 2004 | Daily News

A final rule by CMS to restrict which facilities qualify for the higher payments due inpatient rehabilitation facilities (IRFs) is expected to be released within two weeks, according to industry and Senate sources.

The draft final rule is still in HHS Secretary Tommy Thompson's office, according to a CMS spokesperson. Industry sources told Inside CMS that the rule is expected to be rapidly cleared by OMB.

March 22, 2004 | Daily News

Employers seeking subsidies for maintaining retiree drug coverage will only be able to count their contributions, but not the premiums paid by retirees, to meet the statutory test for the minimum level of benefits, incoming CMS Administrator Mark McClellan has told the Senate Finance Committee.

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