As insurance companies raise flags about the cost of GLP-1 weight loss drugs in coordination with government payer programs, the Trump administration has rescinded its plan to have insurance companies fund coverage of the obesity drugs and will have Medicare pay the cost instead.
Last year, the White House announced a landmark deal...National News
As drug prices continue to rise and seniors struggle to keep up with inflated costs, a new Senate bill seeks to change the way Medicare Part D plans cover cheaper options.
Senators James Lankford (R-Okla.) and Maggie Hassan (D-N.H.) introduced the Ensuring Access to Lower-Cost Medicines for Seniors Act, which would require Part D...White Papers, E books, Reports and more
Actuarial consultant Milliman published a post on its major takeaways for the 2026 Medicare Advantage and prescription drug bids.
The brief was written in order to elucidate industry and policy changes to key stakeholders, including life sciences companies, since the Inflation Reduction Act (IRA) implemented changes to prescription...
President Donald Trump ran his campaign last year with a promise to lower drug prices for Americans, and his latest plan to do so includes the creation of a website for patients to purchase drugs at a discount from pharmaceutical companies. However, Trump may substantially undermine his drug pricing goals with consequences from tariffs...
In a report released this week by the HHS Office of Inspector General, the leading federal agency focused on combating healthcare fraud emphasized the OIG's audits, evaluations, and investigations consistently identify a high risk of fraud, waste, and abuse in the Medicare Advantage risk adjustment program, which provides higher...CMS Rules
The Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) continued its research series on the Inflation Reduction Act this week with a look at the impact of the $2,000 Part D out-of-pocket cap on prescription drugs.
Under the Inflation Reduction Act (IRA), 11 million Medicare Part D...White Papers, E books, Reports and more
Medicare Advantage plans must "fundamentally reassess" their business due to changes in the MA Star Ratings program, according to a new report by Milliman.
The Centers for Medicare and Medicaid Services (CMS) released the 2025 Star Ratings in October, with a noted decline in ratings for Medicare Advantage Part D plans. Part D plans...News
As part of the ongoing Inflation Reduction Act Research Series, the Assistant Secretary for Planning and Education (APSE) Office of Health Policy published an issue brief on the number of Medicare Part D enrollees who reached the out-of-pocket cap on prescription drugs by June 2024.
The issue brief found that 1.5 million enrollees...
Humana's rough patch continues as it sues the U.S. Department of Health and Human Services over star ratings and revisits a potential merger with Cigna.
This month, Humana reached a $90 million settlement with the United States over allegations of fraudulent bids submitted to the Centers for Medicare and Medicaid Services (CMS) for...
The CMS Innovation Center is seeking feedback on the Medicare $2 Drug List (M2DL) voluntary model that would test whether standardized cost sharing for low-cost generics can improve medication adherence and health outcomes along with Medicare beneficiaries' and prescribers' satisfaction with the Part D program.
The model is designed...
One of the main provisions of the Inflation Reduction Act's Medicare reform package directly lowers out-of-pocket costs for beneficiaries by capping total individual spending at $2,000 per year. This is causing some issues in practice, which conservatives are seizing upon to criticize the program.
It also instructs insurers to cover...
On August 15, the Biden administration announced new, lower prices for 10 drugs after the first cycle of negotiations under the new Medicare Drug Price Negotiation Program; prices are set to take effect in 2026.
The 2022 Inflation Reduction Act (IRA), aims to bring substantial savings for older Americans and Medicare. The law...
This week, health payer consultancy Milliman released its annual 2024 Retiree Health Cost Index which projects how much a 65-year-old can expect to spend on healthcare costs after retirement.
The study found that the average couple would need to save $395,000 prior to retirement for healthcare expenditures alone. It found that the...CMS Rules
On Tuesday, the Biden administration released guidance on rules for the Medicare Prescription Payment Plan, a key aspect of the healthcare initiatives laid out in the Inflation Reduction Act of 2022 that aims to lower out-of-pocket costs for seniors with Medicare Part D prescription drug coverage.
The program is slated to launch in...
On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
The Centers for Medicare and Medicaid Services (CMS) have taken the next step on the Medicare Prescription Payment Plan draft guidance, which is required by the Inflation Reduction Act of 2022 to advance President Joe Biden's plan to lower drug costs for seniors.
The draft guidance provides communication and education requirements for...CMS Rules
Low-income Medicare beneficiaries are expected to see some much needed relief as a result of a new rule issued by the Centers for Medicare and Medicaid Services (CMS) this week. The rule seeks to simplify the enrollment and renewal processes for Medicare Savings Programs (MSPs), as many beneficiaries are currently encumbered from...Arizona News
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
Set to begin in 2025, the option to pay out-of-pocket costs for Part D drugs in monthly payments over a year was ratified in the Inflation Reduction Act (IRA).
CMS is releasing the guidance in two parts, this week the focus across 56 pages is on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and...
The Medicare Payment Advisory Committee (MedPAC) submitted its
March 2023 Report to Congress which included its 2024 payment recommendations for Medicare fee-for-service (FFS), Medicare Advantage (MA) and the Medicare prescription drug program (Part D). This year's report is likely to please no one as the committee took aim at claims of...
