Tara Dwyer on Prescription Drugs

Wyden’s C-THRU Act – Publicizing PBM Rebate Data

Last week, Senate Finance Committee Ranking Member Ron Wyden (D- Ore.) introduced the “Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017.” As its name suggests, it seeks to require parties (e.g., PBMs)...more

3/22/2017 / Department of Health and Human Services (HHS) , Disclosure , Drug Pricing , Medicare Part D , Pharmaceutical Industry , Prescription Drugs , Proposed Legislation , Rebates , Sensitive Business Information , State Health Insurance Exchanges , Transparency

2018 Notice of Benefits and Payment: Proposed Updates to the HHS Risk Adjustment Model

Last week, the Centers for Medicare & Medicaid Services (“CMS”) released its 2018 Notice of Benefit and Payment setting out payment parameters for the Health Insurance Marketplace for upcoming years. With several insurers...more

9/8/2016 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Prescription Drug Coverage , Prescription Drugs

Part D Woes, According to the OIG

On June 23, 2015, the OIG issued two reports focusing on fraud, waste, and abuse in the Part D program, the first “Ensuring the Integrity of Medicare Part D” and the second “Questionable Billing Practices and Geographic...more

7/2/2015 / Centers for Medicare & Medicaid Services (CMS) , Fraud Alerts , Healthcare , Medicare , Medicare Part D , OIG , Prescription Drug Coverage , Prescription Drugs

CMS Changes Medicare Prescriber Enrollment Requirements

On May 6, 2015, CMS issued interim final rules relating to Medicare Part D beneficiary access to Part D drugs. Through the rules, CMS announced updates regarding the impending prescriber enroll or opt-out effective date,...more

5/15/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Medicare , Medicare Part D , Prescription Drugs , Proposed Regulation

Front End Changes and, Again, More DIR Columns

Since the beginning of the Medicare Part D program, CMS has introduced many reporting mechanisms for trying to understand drug pricing, price concessions, and the cost of providing services to Part D members. The tool CMS...more

10/20/2014 / Centers for Medicare & Medicaid Services (CMS) , Health Plan Sponsors , Healthcare , Hospitals , Medicare Part D , Pharmaceutical Industry , Pharmacies , Prescription Drug Coverage , Prescription Drugs , Reporting Requirements

Prescription Drugs: Refocusing the False Claims Act Microscope on the Rest of the Transaction

Over the last decade, it has often felt as though the pharmaceutical industry has been the government’s and whistleblowers’ main, and at times only, target for False Claims Act (“FCA”) investigations. While manufacturers are...more

8/26/2014 / False Claims Act (FCA) , Medicaid , Medicare , Medicare Part D , Pharmaceutical Industry , Pharmacies , Prescription Drugs , Walgreens , Whistleblowers

2014 Final Call Letter: CMS Raises Medicare Advantage Rates but Foreshadows Other Significant Program Changes

After receiving many comments on its Draft Call Letter, CMS published its Contract Year 2014 Final Call Letter on April 1, 2013. The Final Call Letter addresses a wide variety of issues that will affect all parties involved...more

4/17/2013 / Beneficiaries , Centers for Medicare & Medicaid Services (CMS) , Controlled Substances , Medical Reimbursement Plans , Medicare Advantage , Modification , Pharmacies , Point of Sale Terminals , Prescription Drugs , Waivers

Tara Dwyer

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