Prescription Drugs Archives - Page 2 of 3

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 Finalizes Proposal to Require Drug Manufacturers Include List Price in Direct-to-Consumer Television Advertisements

This morning, the Centers for Medicare and Medicaid Services (CMS) released a final rule that will require pharmaceutical manufacturers to include the list price of a drug in direct-to-consumer (DTC) television advertisements. This idea was initially included in the administration’s drug pricing blueprint, American Patients First, and proposed in a rule released in October 2018. [...] Read More

CMS Lets Plans off With a Warning Regarding Generics, But Increased Out-of-Pocket Threshold for 2020 Looms Large

On April 1, 2019, CMS released the final Medicare Advantage and Part D Call Letter for the 2020 plan year. While the Call Letter itself was relatively quiet, compared to other Administration activities around the two benefits, CMS pulled back on a proposal to limit plan sponsors from placing generic drugs on tiers labeled “brand” [...] Read More

Three Years After First Final Rule, CMS Again Declines to Define Line Extensions

This evening, the Centers for Medicare and Medicaid Services (CMS) released a final rule and interim final rule relate to line extensions for covered outpatient drugs in the Medicaid program. This release is in response to a final rule with comment period that was released in early 2016. No Definition of Line Extension Adopted by [...] Read More

CMS Office of the Actuary Releases Projections of National Health Expenditures for the Next Decade

CMS’ Office of the Actuary released a report this week on 2018-2027 projections of national health expenditures. Health care spending is expected to rise from 17.9% to 19.4% of gross domestic product (GDP), an annual rise of 5.5 %, in the next decade. CMS states that the key drivers for the rise in expenditures will [...] Read More

OIG to Pharma: PBM Rebates Out, POS Rebates In

On January 31, 2019, the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) issued a proposed rule that would, if finalized, remove the existing legal “safe harbor” that protects rebates currently negotiated between pharmaceutical manufacturers and Medicare Part D prescription drug plans and Medicaid plans. In its place, the agency [...] Read More

Proposals for 2020 Medicare Advantage and Part D Plans Released, Opioids and Generic Access Continue to be a Focus

The Center for Medicare and Medicaid Services (CMS) has released the plan year 2020 Draft Call Letter outlining proposed changes to policies impacting Medicare Advantage (MA) and Part D prescription drug plans (PDPs). The agency is continuing to focus on changes that will modernize the MA and PDP benefits to make the plans operate closer [...] Read More

New Innovation Model for Part D Announced, Medicare Advantage VBID Model to Expand

On Friday, January 18, the Centers for Medicare and Medicaid Services (CMS) announced two new model programs that will be available to Medicare Part D and Medicare Advantage plans in 2020: Part D Modernization Model. The model, which would run for five years, and would be voluntary, would require plan sponsors to take on additional [...] 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

HHS to Require List Prices in Direct-to-Consumer Television Advertisement for Prescription Drugs

This afternoon, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule related to drug pricing transparency as part of the administration’s continuing effort to combat high drug prices. Comments on the proposed regulation are due on December 17, 2018. While the rule cites elements of the Social Security Act as the source […]

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Archive Tag: Prescription Drugs