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 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.
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
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.
CMS hopes the changes will increase healthcare access for underserved populations, streamline the plan selection process and simplify enrolling in Marketplace coverage.
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.
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.
Hear executives from Quantum Health, Surescripts, EY, Clinical Architecture and Personify Health share their views on digital transformation in healthcare.
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.
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 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.
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 future looks bright for the integrated specialty pharmacy model – for health systems, providers, and most importantly, for patients.
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 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.
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 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.
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.