Stephnie John on Centers for Medicare & Medicaid Services (CMS)

CMS’s 2026 Final Medicare Advantage Rule Focuses on Implementing the IRA and Deregulation

In April, CMS finalized its Contract Year (CY) 2026 Medicare Advantage and Part D Final Rule (Final Rule). With CMS releasing the 2026 Medicare Advantage and Part D Proposed Rule in December under the Biden Administration,...more

5/9/2025 / Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Inflation Reduction Act (IRA) , Medicare Advantage , Medicare Part D , Prescription Drugs , Proposed Rules , Regulatory Reform , Trump Administration

CMS’s ACA Marketplace Integrity and Affordability Proposed Rule – What it may mean for Health Plans

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its 2025 Marketplace Integrity and Affordability Proposed Rule (Proposed Rule), proposing a number of enrollment and eligibility policies...more

3/25/2025 / Affordable Care Act , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , DACA , Department of Health and Human Services (HHS) , Enrollment , Federal Poverty Line , Gender Identity , Health Insurance , Healthcare Reform , Inflation Reduction Act (IRA) , Insurance Industry , Out-of-Pocket Expenses , Proposed Rules , Regulatory Agenda , Regulatory Reform , Regulatory Requirements

Mintz IRA Update — The IRA in 2025: The Future of Medicare Part D

Last year was a pivotal year for the pharmaceutical industry. Under the IRA’s Medicare Drug Price Negotiation Program (the Negotiation Program), the US government negotiated the prices of 10 selected high-expenditure,...more

2/14/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare Reform , Inflation Reduction Act (IRA) , Medicare , Medicare Part D , Pharmaceutical Industry , Prescription Drugs

[Podcast] Health Law Diagnosed – New Year's Gratitude

In the latest episode of Health Law Diagnosed, host Of Counsel Bridgette Keller invites the Mintz Health Law team to reflect on what they’re grateful for as they prepare for the year ahead. Hear from a dynamic group of...more

2/4/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , Medicare , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Regulatory Requirements , Value-Based Care

Health Law Diagnosed – New Year's Gratitude

In the latest episode of Health Law Diagnosed, host Of Counsel Bridgette Keller invites the Mintz Health Law team to reflect on what they’re grateful for as they prepare for the year ahead....more

2/4/2025 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare , Pharmacy Benefit Manager (PBM) , Regulatory Requirements , Value-Based Care

PBM Policy and Legislative Update — Summer 2024

Mintz’s PBM practice is pleased to present a 2024 year-to-date PBM Policy and Legislative Update. This edition builds upon prior issues and summarizes activity from January through June that impacts the PBM industry. It...more

8/1/2024 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Supply Chain , Telehealth , Transparency

Mintz IRA Update — Learning From Experience: Medicare Drug Price Negotiation Program Updates

Since our last edition of the Mintz IRA Update, the Medicare Drug Price Negotiation Program (the “Negotiation Program” or “Program”) and related maximum fair price (MFP) negotiation process for each of the 10 high-expenditure...more

7/16/2024 / American Hospital Association , Centers for Medicare & Medicaid Services (CMS) , Draft Guidance , Drug Pricing , Inflation Reduction Act (IRA) , Medicare , Negotiations , PHRMA , Section 340B

Mintz IRA Update — The Consequences and Costs of Redesigning the Part D Program

The passage of the Inflation Reduction Act of 2022 (IRA) marked a significant milestone in Congress’s ongoing efforts to address escalating health care costs. While the IRA aims to rein in government spending on Medicare and...more

7/16/2024 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Health Insurance , Health Plan Sponsors , Inflation Reduction Act (IRA) , Manufacturers , Medicare Part D , Out-of-Pocket Expenses , Reimbursements

Mintz IRA Update — The IRA in 2024: The Medicare Drug Price Negotiation Program in Full Swing and Other Developments

Our team’s preparation for the year includes a review of the anticipated impact of the IRA on the health care industry in 2024. Many of the IRA’s key provisions that go into effect this year are centered around two main...more

3/18/2024 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Healthcare , Inflation Reduction Act (IRA) , Medicare , Medicare Part D , Negotiations , Prescription Drugs

Transforming Primary Care: CMS Launches Making Care Primary (MCP) Model

The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model—the Making Care Primary (MCP) Model—geared towards smaller, independent primary care practices and organizations that want to participate...more

8/9/2023 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Infrastructure , Medicaid , Medicare Shared Savings Program , Performance Incentives , Value-Based Care

Medicaid Best Price 101: A Review of Medicaid Best Price Policy and New CMS Guidance on Medicaid Best Price Reporting for Value...

At the end of March 2022, the Centers for Medicare & Medicaid Services (CMS) released guidance to drug manufacturers and states on reporting Medicaid Best Price under value based purchasing (VBP) arrangements (Medicaid Best...more

4/27/2022 / Centers for Medicare & Medicaid Services (CMS) , Department of Veterans Affairs , Final Rules , Medicaid , Medicaid Drug Rebate Program , Medicare Coverage Gap Discount Program , Medicare Part D , New Guidance , Section 340B , Value-Based Purchasing

Building on the Success of Medicare-Medicaid Plans, CMS Proposes Modifications for D-SNPs

As we noted, Centers for Medicare & Medicaid Services (CMS) recently proposed its Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs rules (Proposed...more

1/17/2022 / Centers for Medicare & Medicaid Services (CMS) , HRA , Long-Term Care , Medicaid , Medicare , Medicare Advantage

Stephnie John

Mintz

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