But cost sharing for non-preferred specialty drugs cannot exceed the current 25%-33% coinsurance currently allowed for the specialty tier, the Centers for Medicare and Medicaid Services says in a proposed rule.
The Centers for Medicare and Medicaid Services is proposing to allow Medicare Advantage and Medicare Part D plans to add a second, “preferred” specialty drug formulary tier with lower cost sharing beginning in 2021 as a way to “enhance” price negotiations with manufacturers and promote the use of lower-cost biosimilars.
The idea is offered in a proposed rule on policy and technical changes to the Medicare Advantage and Part...
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.
