Biopharma manufacturers view implementation of management tool in Medicare Advantage plans with concern, urge US Centers for Medicare and Medicaid Services to withdraw permission for use of step therapy for Part B drugs.
Humana Inc.’s Medicare Advantage plans will impose step therapy requirements on more than 40 injectable prescription drugs and viscosupplements covered by Medicare Part B in 2019, including treatments for cancer and supportive care therapy for patients undergoing chemotherapy.
With step therapy, payers require members to try and fail on preferred, often lower cost drugs before coverage is granted...
The Centers for Medicare and Medicaid Services is considering imposing price inflation rebates on Part B drugs furnished to enrollees in Medicare Advantage plans in addition to those covered by fee-for-service Medicare.
Doctors are increasingly falling victim to financial scams due to their high incomes, busy schedules, and trust in professional networks. Recognizing the tactics scammers use and the reasons behind physicians’ susceptibility is essential for protecting medical professionals.
US lawmakers will undoubtedly continue to work on pharmacy benefit manager reform legislation in 2025, given its bipartisan support. But policies impacting rebates that could lead to higher premiums in Part D may be a tough sell in the midst of the benefit redesign.
Medicare coverage with evidence development final guidance includes few substantive changes from the proposed version despite biopharma stakeholder concerns.
Congressional Budget Office responses to questions from US lawmakers on pharmacy benefit managers could add to the momentum for PBM reforms to go further than the current leading proposals.
Pink Sheet reporter and editors discuss the take-aways from the landmark first Medicare negotiated drug prices and what additional information remains outstanding.
But the amount of savings realized when the Medicare negotiated prices go into effect in 2026 remains the subject of debate.
