Tag Archives: Part D

Obstruction of a Medicare Audit Doesn’t Require Direct Obstruction of a Federal Agent

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
A registered pharmacist, the owner of two Alabama pharmacies, pleaded guilty to obstructing a 2012 federal audit of Medicare claims and agreed to pay a $2.5 million penalty to the government. The submission of the false and misleading documents by the pharmacy owner constituted obstruction of a federal audit of his Medicare claims, even though … Continue Reading

New Medicare Part B Payment Model is Most Recent Payor Response to Increasing Drug Prices

Photo of Lee H. RosebushBy Lee H. Rosebush and Nita Garg on Posted in Uncategorized
Recent activity by the federal government along with commercial payors may be indicative of further changes to how payors, providers, and pharmaceutical manufacturers engage in prescription drug arrangements. A recently announced proposed rule by CMS would create a new Medicare Part B prescription drug payment model intended to improve quality of care and deliver better value for … Continue Reading

CMS Doubles Down on Targeting Part D Enrollee Prescription Drug Abuse, But Will Stakeholders Agree?

By Kameron Brackins on Posted in Uncategorized
With the release of its 2017 draft call letter, CMS continues its push to curb opioid dependence, overdose and death among Medicare Part D enrollees. To that end, CMS proposes that Part D plan sponsors edit their benefit designs to target opioid overutilization at the point-of-sale. The letter also reminds Part D sponsors that benefit designs … Continue Reading

Providers Oppose CMS Proposal Targeting Prescription Drug Abuse by Part D Enrollees

By Kameron Brackins on Posted in Uncategorized
Providers have voiced opposition to a proposal aimed at targeting Medicare Part D enrollees with “potential opioid or acetaminophen overutilization issues that indicate the need to implement appropriate controls on these drugs for the identified beneficiaries.” Under a recently proposed rule on revised discharge planning requirements, CMS solicited comments on whether providers should be required to consult … Continue Reading

New Data on Part D Prescription Drugs Available

Photo of Lee H. RosebushBy Lee H. Rosebush and Nita Garg on Posted in Uncategorized
On April 30, 2015, the Centers for Medicare & Medicaid Services (CMS) made available a dataset that provides detailed information on medications that physicians and other healthcare providers prescribed under the Medicare Part D Prescription Drug Program in 2013. CMS intends for this dataset to provide “key information to consumers, providers, researchers, and other stakeholders … Continue Reading

Following FDA’s First Biosimilar License, CMS Issues Guidance on Reimbursement for Biosimilars

Photo of Lee H. RosebushPhoto of Lindsay HolmesBy Lee H. Rosebush and Lindsay Holmes on Posted in Uncategorized
On March 6, 2015, FDA released a statement announcing its issuance of the first biosimilar license to Zarxio. In the same month, CMS issued a number of guidance documents addressing reimbursement for biosimilars under the Medicare Part B, Part D, and Medicaid programs. This is an initial step for CMS, and more guidance is likely … Continue Reading

CMS Fines Insurer for Misleading Medicare Part D Beneficiaries

Photo of Lee H. RosebushBy Lee H. Rosebush and Dena Kessler on Posted in Uncategorized
The federal agency that oversees Medicare’s prescription drug program has alleged that a major U.S. insurance company misled beneficiaries about the pharmacies included in the company’s drug plan, and imposed a $1 million fine. According to a civil monetary notice issued by the Centers for Medicare and Medicaid Services (CMS), Aetna Inc. improperly reported that … Continue Reading

Medicare Advantage and Medicare Part D Changes for 2016 Released

Photo of Lee H. RosebushBy Nita Garg and Lee H. Rosebush on Posted in Uncategorized
On February 6, 2015, the Centers for Medicare & Medicaid Services (CMS) released a final rule regarding changes to Medicare Advantage and Medicare Part D to take effect in 2016. According to CMS, this final rule “implements statutory requirements, improves program efficiencies, strengthens beneficiary protections, clarifies program requirements, improves payment accuracy, and makes technical changes … Continue Reading
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