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CMS Seeks Part D, Advantage Changes to Save $1.3B, Curb Abuses
In an effort to save $1.3 billion over five years and curb the abuse of prescription drugs that Medicare pays for, the CMS is proposing an array of changes to Medicare's Part D and Advantage programs.
In an effort to save $1.3 billion over five years and curb the abuse of prescription drugs that Medicare pays for, the CMS is proposing an array of changes to Medicare's Part D and Advantage programs.
The suggestions range from cutting the number of plans to ensure more meaningful plan choices, ending coverage for drugs for certain illnesses, and changing the way in which pharmacies bid to be included in plans.
The CMS is suggesting that each payer offer no more than two Part D plans in the same service area, saying the limit would give consumers “meaningful differences” in coverage options. The proposed rule would also prohibit Advantage plans from offering coverage options that replace plans the CMS previously required the carrier to terminate or consolidate due to low enrollment.
Read the full story here: http://bit.ly/1a8g4CO
Source: Modern Healthcare
What's at Stake as Oral Arguments Are Presented in the Braidwood Case? Q&A With Richard Hughes IV
April 21st 2025Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage
April 4th 2025This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.
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