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.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
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.
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.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
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.
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.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
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.
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.
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.