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On 3 May, the Centers for Medicare & Medicaid Services issued draft guidance for initial price applicability year 2027 of the Drug Price Negotiation Program established by the IRA. Read our insights here. https://lnkd.in/ehBqZyN9 #IRA #drugpricing

Digital therapeutics are making strides in obtaining Medicare reimbursement, starting in the #mentalhealth space. In our latest blog, we cover the latest on this movement by the Centers for Medicare and Medicaid Services as well as future implications for #DTx coverage. Read the full blog: https://lnkd.in/ejYXsrH4 #digitaltherapeutics #medicarereimbursement #telemedicine #mentalhealthcare

For those less familiar with the 340B space, RxParadigm will be publishing a series of 340B Facts. Did you know: California has carved out pharmacy benefit from Medicaid managed care plans and exclusively uses a Fee for Service model. #340BProgram #MedicaidManagedCare #FeeforService #RxParadigm #340BDuplicateDiscount #California

The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid: https://nej.md/3xoXUmU

In December 2023, the Centers for Medicare & Medicaid Services announced shadow bundle data would be distributed to all Shared Savings Program Accountable Care Organizations starting in February 2024. The data will include episode-level claims files, target prices, and summary reports. Learn more in this article from FORVIS.

BREAKING INFLATION REDUCTION ACT NEWS: Centers for Medicare & Medicaid Services released the final part one guidance for the new Medicare Prescription Payment Plan for Part D plan sponsors. https://lnkd.in/emsS78Hb The final part one guidance outlines the necessary operational requirements Part D plan sponsors and addresses topics such as: - Identifying Part D enrollees likely to benefit from the program - The opt-in process for Part D enrollees, and - Program participant protections, and the data collection needed to evaluate the program. The final part one guidance requires Part D sponsors to notify a pharmacy to provide information on the program for anyone who meets a $600 out-of-pocket threshold based on a single prescription at the point-of-sale. The guidance also finalizes the requirement that Part D sponsors must process election requests within 24 hours during the plan year. #pharma #inflationreductionact #managedcare #marketaccess Learn more below 👇 👇 👇

The Centers for Medicare and Medicaid Services (CMS) released the FY 2025 Hospice Payment Rate Update Proposed Rule last week with proposed changes in reimbursement and other regulations for providers. Dive into the key components of the proposed rule and its potential impact on hospice providers during our upcoming webinar. Our experts will provide a comprehensive overview of the proposed changes, including updates to payment rates, quality reporting requirements, and regulatory updates. Register now: https://okt.to/5A6bzu

The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes it through the rulemaking process, the proposed model would launch on Jan. 1, 2026 and run for five years, ending on Dec. 31, 2030. The model would be mandatory for five types of surgical procedures: Lower extremity joint replacement; Surgical hip femur fracture treatment; Spinal fusion; Coronary artery bypass graft; and Major bowel procedures. These procedures would “initiate” the episode.

📢 New Insights on PBM Oversight in Medicaid Managed Care: As states work to navigate the complexities of Medicaid Managed Care, Pharmacy Benefit Manager (PBM) oversight is critical for ensuring transparency and accountability. Our latest article explores strategic approaches for improving PBM oversight and driving better outcomes. Read it here: https://okt.to/wC8tJF

The Centers for Medicare & Medicaid Services (CMS) have announced key changes for 2025. These updates, which affect Part D of the drug benefit program, are crucial for anyone involved with Medicaid, Medicare, and CHIP. To understand these regulatory requirements and their impact, head over to our blog for more details! https://bit.ly/3RJdbWF