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Archive Tag: medicare advantage

CMS Finalizes CY 2023 Policy Changes for Medicare Advantage and Part D Plans; Including Patient Cost-Sharing, Patient Protections, and Provider Accessibility

On April 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released its final rule and a fact sheet, containing policies for Medicare Advantage (MA) and Medicare Part D plans in CY (contract year) 2023. The rule includes the following changes: Redefining ‘negotiated price’ for Part D drugs so prices at point of sale [...] Read More

Has Medicare Advantage achieved its promises?

The Medicare Advantage program (also known as Medicare Part C)  has long been touted for its potential to lower costs, expand consumer choice, and improve health outcomes.[i] The popularity of Medicare Advantage (MA) plans has increased in the past decade with prospective enrollees enticed by benefits ranging from dental care to pest control and targeted [...] Read More

CMS Proposes Adding Second Specialty Tier Option to Part D, Additional Opioid Drug Management Programs; Call Letter Includes Technical Updates

CMS has released a proposed rule that would update program policies for Medicare Advantage and Medicare Part D beginning in 2021, if finalized. CMS has also released the draft Call Letter for 2021; however, this year’s Call Letter is limited to standard benefit parameters, risk-sharing, and other technical details and does not feature any additional [...] Read More

CMS Scales Back Proposed Changes to Part D Protected Classes; Step Therapy Expected to Bring Savings to Beneficiaries and Taxpayers

This evening, the Centers for Medicare and Medicaid Services (CMS) released a final rule entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.” In total, the agency estimates that beneficiaries will save $62 million over 10 years in out-of-pocket spending, and Medicare program costs will be reduced by an [...] Read More

CMS Releases Proposed Rule on Medicare Part D and Medicare Advantage, Proposes Changes Related to Step Therapy & Protected Classes, Considers Broader Definition of “Negotiated Price”

Overview This evening, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.” CMS believes that the changes proposed in this rule will give plans more tools to negotiate lower drug prices. The proposed rule discusses the definition [...] Read More

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