News & Analysis as of

Reimbursements Drug Pricing Outpatient Prospective Payment System (OPPS)

Hogan Lovells

Medicare proposed rules include government pricing surprises: ASP changes and maximum fair price, new bona fide service fee and...

Hogan Lovells on

Every July, the Centers for Medicare & Medicaid Services (CMS) publishes two proposed rules relating to how it plans to administer the Medicare Part B program for the next calendar year: the physician fee schedule (PFS)...more

King & Spalding

Court Rules on Retrospective Relief for 340B Hospitals Without Vacating CMS’s Rules

King & Spalding on

On January 10, 2023, Judge Contreras of the United States District Court for the District of Columbia ruled that CMS’s 340B drug reimbursement rates dating back to January 1, 2018, were unlawful and underpaid affected...more

K&L Gates LLP

Recent Developments to the 340B Drug Pricing Program

K&L Gates LLP on

In this episode Victoria Hamscho, Andrew Ruskin, and Leah Richardson provide an update on key developments to the 340B Program. They discuss the effects of the Supreme Court’s decision earlier this year overturning 340B...more

Bass, Berry & Sims PLC

CMS Reverses 340B Payment Cuts for 2023 but Does Not Address Remedy for Prior Years

Bass, Berry & Sims PLC on

On November 3, the Centers for Medicare & Medicaid Services (CMS) issued an update to its Medicare Part B drug payment policy for hospitals participating in the 340B drug pricing program and reversed payment cuts in place...more

King & Spalding

Court Rules HHS Must Pay 340B Hospitals the Correct Outpatient Drug Reimbursement Rate for the Remainder of the Year

King & Spalding on

The United States District Court for the District of Columbia granted plaintiffs’ motion to vacate the 2022 OPPS Rule’s 340B rates on a prospective basis, meaning that HHS will pay 340B hospitals the drug’s average sales...more

McDermott Will & Emery

District Court Vacates 340B Cuts, But Don’t Expect Immediate Payment Rate Restoration

McDermott Will & Emery on

On September 28, 2022, the US District Court for the District of Columbia vacated the 2022 rule under which the US Department of Health and Human Services (HHS) reduced Medicare Part B payments on 340B drugs paid under the...more

Foley & Lardner LLP

340B Rate Cuts Reversed by CMS for 2023

Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) has announced that it “fully expects” to reverse Medicare Part B rate cuts for separately payable drugs acquired through the 340B Drug Pricing Program, resulting in an...more

Foley & Lardner LLP

340B Hospitals Win in Medicare OPPS Supreme Court Decision

Foley & Lardner LLP on

The Supreme Court issued a long-awaited victory to 340B hospitals this week, when it held in American Hospital Association et al. v. Becerra et al. that the Department of Health and Human Services (HHS) had set unlawful...more

Bricker Graydon LLP

Supreme Court unanimously sides with American Hospital Association, 340B hospitals over outpatient drug reimbursement rates; 340B...

Bricker Graydon LLP on

On Friday, June 24th, the Supreme Court unanimously agreed with the American Hospital Association (AHA) and 340B hospitals regarding their challenge to outpatient prescription drug reimbursement methodologies issued by the...more

Polsinelli

Medicare 340B Payment Cut Déjà vu – Biden Administration Continues Trump Administration Part B Payment Reductions

Polsinelli on

On Monday, July 19, 2021, the Centers for Medicare and Medicaid Services (CMS) released the CY 2022 Medicare Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule (Proposed Rule). While the Proposed Rule...more

K&L Gates LLP

Hospitals Ask Supreme Court to Reverse Site-Neutral, 340B Payment Rulings

K&L Gates LLP on

How far can an agency go to allow agency-developed policy objectives to supersede concerns about faithful adherence to the law? Similarly, how much should health systems and others regulated by Medicare be concerned about...more

McDermott Will & Emery

CMS Proposes Further OPPS Reductions to 340B Drug Reimbursement Rates

McDermott Will & Emery on

On August 4, 2020, the Centers for Medicare & Medicaid Services (CMS) released its CY 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule. CMS proposes to reduce OPPS payments for 340B drugs from...more

K&L Gates LLP

K&L Gates Triage: Looking Ahead to 2020: Developing Issues in Pharmacy Law and the 340B Drug Pricing Program

K&L Gates LLP on

In this episode, Ryan Severson and Victoria Hamscho discuss recent developments in pharmaceutical pricing and the 340B Drug Pricing Program heading into 2020, including reimbursement cuts for 340B drugs under the Outpatient...more

K&L Gates LLP

K&L Gates Triage: Recent Developments Impacting Drug Pricing and the 340B Program: Part 2

K&L Gates LLP on

In Part Two of this two-part series on recent developments in pharmacy law and the 340B drug pricing program, Richard Church and Ryan Severson discuss several recent developments related to the 340B drug pricing program,...more

Bricker Graydon LLP

Could relief from the Medicare cuts in reimbursement for 340B drugs be coming soon for hospitals?

Bricker Graydon LLP on

Relief for hospitals that have endured drastic cuts in Medicare reimbursement for the majority of drugs they purchase under the 340B drug discount program may be coming soon. A federal judge recently affirmed his prior...more

K&L Gates LLP

K&L Gates Triage: 340B Eligibility - Hospital Covered Entities

K&L Gates LLP on

This podcast focuses on the eligibility requirements for hospitals participating in the 340B Drug Pricing Program. Factors affecting eligibility include a hospital’s licensure status, patient population, and Medicare...more

Polsinelli

340B Covered Entities Beware: CMS Proposes Drastic Drug Reimbursement Rate Cuts

Polsinelli on

In its Outpatient Prospective Payment System proposed rule ("Proposed Rule"), CMS outlined a significant Medicare Part B payment reduction for separately payable, nonpassthrough drugs provided in the hospital outpatient...more

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