Judge Richard Leon granted the settlement between the federal government and CVS Health, which divests Aetna’s Medicare Part D prescription drug plan (PDP) to WellCare.
The judge stated that the...
The Office of Inspector General (OIG) audited Medicare spending and found that CMS spent $160.8 million paying for drugs that should have been covered by hospices. This data follows a 2012 OIG report...
After facing over $100 billion in Medicare Part D expenditures in 2016, Congress called on the Government Accountability Office to discern the pharmacy benefits manager’s (PBM’s) role in...
A Humana study comparing the differences in medication therapy management (MTM) services found that targeted medication reviews (TMR) were highly successful interventions.
“This study highlights...
The average basic Medicare Part D premium for prescription drug plans is projected to decline, CMS announced.
“CMS has been taking action to lower the cost of prescription drugs, and we are...
The Senate Finance Committee has passed the Prescription Drug Pricing Reduction Act (PDPRA), a bipartisan piece of legislation that checks pharmacy benefit managers’ practices of overpayment and...
A recent Health Affairs study found that some Medicare beneficiaries would pay higher out-of-pocket costs for generic drugs than for specialty or brand-name drugs.
Researchers from Vanderbilt...
A new rule from CMS calls for electronic prior authorization (ePA) updates, aiming to improve prescribers’ decision-making processes, ease administrative burden, and decrease the wait time for...
Total prescription drug spending reached $333 billion in 2017, but the way that lump sum was divided among Medicare, Medicaid, and employer-sponsored health plans may reveal differences between the...
CMS has finalized new Medicare Advantage and Part D payment policies for 2020 that will increase competition among health plans, leading to higher quality care at lower costs.
The changes will...
CMS has introduced new Medicare Part D patient safety policies that will address the opioid epidemic while still preserving medically necessary access to pain management therapies.
The new policies...
Net prescription drug spending increased from $250.7 billion in 2012 to $341 billion in 2016, according to a new report from the Pew Charitable Trusts.
The report also found that over the same period,...
HHS has announced a proposal that would essentially eliminate the existing drug rebate process and instead encourage direct discounts to patients in an effort to control the costs of prescription...
CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices...
Cigna secured approvals from New York and California to acquire Express Scripts, according to multiple reports.
Zachary Vasile of the Journal Inquirer reports that New Jersey is the remaining state...
While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times.
With...
CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed...
Close to a year has passed since CVS Health announced its plan to acquire Aetna in a $69-billion acquisition. Now only the approval of two state departments of insurance stands in its way.
In a recent...
New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to...
CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice.
A memo from the agency highlights a...
