Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less.

The post CEO of For-Profit MA Plan Tells CMS “Pay Us Less” appeared first on MedCity News.

The 15 drugs selected for the Centers for Medicare and Medicaid Services drug price negotiation program accounted for about $27 billion in total prescription spending under Medicare Parts B and D. But this revenue from Medicare makes up a small percentage of each drug manufacturer’s total sales.

The post With CMS’s New List of Meds for Drug Price Negotiation, Analyst Sees Small Financial Hit to Pharmas appeared first on MedCity News.

Medicare’s physician fee schedule includes billing codes for digital therapeutics for the first time. Stakeholders say these codes could help turn around reimbursement challenges weighing on the entire digital medicines sector.

The post Digital Therapeutics Sector Sees Billing Codes as Key to Breaking Free of Reimbursement Rut appeared first on MedCity News.

The first 10 drugs selected for Medicare price negotiations now have new prices set to take effect in 2026. Industry observers note that most of these drugs are older products facing generic competition soon, so greater industry impact will come as the program expands to more drugs in years to come.

The post CMS Touts First Negotiated Drug Prices, But Greater Impact Expected in Future Rounds appeared first on MedCity News.

Medicare will cover Alzheimer’s disease drugs granted traditional FDA approval, CMS announced. But the decision keeps the spirit of an earlier coverage determination, which called for the gathering of more evidence about the safety and efficacy of these therapies.

The post CMS Will Cover Approved Alzheimer’s Drugs, But It Still Wants More Evidence appeared first on MedCity News.

CMS hopes the changes will increase healthcare access for underserved populations, streamline the plan selection process and simplify enrolling in Marketplace coverage.

The post CMS Releases Proposed Rule to Advance ACA Coverage in 2024 appeared first on MedCity News.

The agency reported that child vaccination rates fell 22% between March and May. CMS said vaccination rates have increased since, but still not enough to make up for the gap.

The post CMS sounds alarm over drop in child vaccinations appeared first on MedCity News.

A Congressional investigation found that outside consultants billed CMS nearly $6 million in less than two years. The expenditures, which included setting up interviews with CMS Administrator Seema Verma, were found by a previous Inspector General audit to violate federal contracting requirements.

The post Report: CMS Administrator spent millions on outside consultants appeared first on MedCity News.

More than 1,750 Medicare part D plans and Medicare Advantage plans will limit out-of-pocket insulin costs to a $35 copay next year. The change would make patients’ out-of-pocket costs more consistent than the current system, where payments fluctuate in different stages of their Part D plan.

The post Insurers will limit insulin costs to $35 copay for Medicare Part D plans next year appeared first on MedCity News.

On Friday, President Donald Trump declared a national emergency related to the Covid-19 pandemic. The Centers for Medicare and Medicaid Services loosened requirements that would make it easier for hospitals to bolster care through telehealth.

The post CMS loosens telehealth laws after national emergency declared for COVID-19 appeared first on MedCity News.

The drug industry maintains that policies like foreign reference pricing and letting Medicare negotiate prices would harm innovation. But closer examination reveals that while there is truth to that claim, it’s more complex than it appears at first glance.

The post How much will drug price controls harm innovation? It depends appeared first on MedCity News.

CMS Administrator Seema Verma unveiled a new demonstration policy that would allow states to pay for Medicaid expansion using block grants. But experts were unsure how many states would opt into them, with possible financial and legal challenges ahead.

The post Experts unsure if states will bet on block grants appeared first on MedCity News.

Under the decision, Medicare patients with inherited cancer mutations such as BRCA will receive coverage for NGS testing. Drugs that treat BRCA-mutated breast and ovarian cancers include AstraZeneca’s Lynparza and Pfizer’s Talzenna.

The post CMS to cover next-generation sequencing for inherited breast, ovarian cancers appeared first on MedCity News.

The House voted 230-192, mostly along party lines, for the Elijah E. Cummings Lower Drug Costs Now Act. The Trump administration has indicated it would veto the bill and stated that it would harm innovation.

The post House passes bill that would require CMS to negotiate some drug prices appeared first on MedCity News.

With the final rule, CMS has signaled to hospitals that they must provide patients with informed choice – not just any choice – of post-acute providers.

The post New CMS rules put the focus on informed patient choice appeared first on MedCity News.

The Medicare coverage decision, issued Wednesday evening after a nearly three-month delay, removes several requirements that some had feared would limit access to the cell therapies, while also allowing for some off-label use.

The post CMS goes for liberal approach in Medicare CAR-T coverage appeared first on MedCity News.

U.S. District Judge Amit Mehta in Washington, D.C. ruled in favor of pharma companies challenging the rule in court because of what he said was a lack of statutory authority from the HHS to govern drug marketing.

The post Federal judge strikes down rule requiring drug prices in TV ads appeared first on MedCity News.

A legal expert said such delays from CMS are unusual. The agency said May 17 that it would delay its long-awaited national coverage determination for CAR-Ts, but since then even drugmakers haven’t been given a reason or timeline.

The post CMS’ coverage determination for CAR-T still delayed after a month, and nobody knows why appeared first on MedCity News.

In a statement, the agency said that a decision on whether to have Medicare cover the cell therapies would not be issued Friday, but would be forthcoming.

The post CMS delays national coverage determination for CAR-T therapies appeared first on MedCity News.

The changes will take place 60 days after the rule is published in the Federal Register. Industry trade group PhRMA have opposed the rule, saying it will lead to consumer confusion and sticker shock that could discourage medication use.

The post HHS implements rule to require list prices in television drug ads appeared first on MedCity News.

Beginning in June, the Livongo for Diabetes program will be available to Medicare Advantage members of Cambia Health Solutions’ regional health plans.

The post CMS OKs Livongo as enrolled provider for Medicare Advantage appeared first on MedCity News.

The agency also proposed increasing the maximum new technology add-on payment from 50 percent to 65 percent for fiscal year 2020.

The post CMS proposes continuing new technology add-on payments for CAR-T cell therapies next year appeared first on MedCity News.

CMS has partnered with the American Academy of Family Physicians and the Laura and John Arnold Foundation to award up to $1.65 million to selected participants.

The post CMS debuts AI competition focused on health outcomes and quality of care appeared first on MedCity News.

Dr. Mark Roche is a former Northwestern University professor and NIH researcher focused on medical informatics and healthcare interoperability. He also served a physician advisor for ONC and HHS/

The post CMS hires its first chief healthcare informatics officer appeared first on MedCity News.

Through the Emergency Triage, Treat and Transport model, CMS will pay ambulance suppliers and providers to transport Medicare beneficiaries to an alternative location (like an urgent care clinic) and to provide treatment in place with a practitioner.

The post CMS reveals new payment model for emergency ambulance services appeared first on MedCity News.

In a letter to state Medicaid directors, the agency said states can pursue reimbursement for short-term residential treatment services in an institution for mental disease.

The post CMS expands coverage of mental health services under Medicaid appeared first on MedCity News.

In a phone interview, Matt Fisher, a partner with Mirick O’Connell, said CMS’ latest actions regarding virtual care are beneficial but noted doctors shouldn’t forget about the privacy and security side of the coin.

The post What CMS’ virtual care moves mean for healthcare at large appeared first on MedCity News.

Medicare will pay for certain communication technology-based services, the remote evaluation of recorded video and/or images and an expanded list of telehealth services.

The post CMS will cover virtual care for the first time appeared first on MedCity News.

Accusations of “freeloading” seen as misleading, and the proposed changes – which would start in 2020 – wouldn’t help patients covered under Part D or commercial plans.

The post Trump calls Medicare Part B proposal ‘revolutionary,’ but experts see limited benefits appeared first on MedCity News.

In a speech at a University of Southern California-Brookings Institution event, Seema Verma pointed to 2016 figures showing more than $1 billion in missed savings.

The post Medicare Part D plans should step up on generic drug utilization, CMS administrator says appeared first on MedCity News.