Aetna、Cigna、Elevance、Humana、United Healthcare 等等。 在开篇提到的,024年8月15日,美国医疗保险和医疗补助服务中心(CMS)公布了首轮医保谈判结果新鲜出炉,本轮谈判便属于Medicare的D部分,专门涵盖处方药保险,B部分谈判则属药械以及相关生...
近日,美国CMS宣布将诺和诺德的减肥药Wegovy纳入Medicare Part D的报销,但仅针对心脏病患者,主要用于降低心梗和中风的风险。这是Medicare首次允许减肥药进入报销目录,虽然只是针对特定人群,而且要经过支付方的预授权(prior authorization),但毕竟标志着医保已经开始报销拥有治疗疾病功能的减肥药。不过,由于法律禁止Medicare纳入...
CMS提議Medicare優勢計劃增加4.33% 周五,美國醫療保險和醫療補助服務中心宣佈提議將政府對醫療保險優勢計劃的付款平均提高4.33%,健康保險公司股價上漲。 Humana(HUM)股價在盤后交易中上漲6%,United Health Group(UNH)股價上漲4%,CVS Health(紐約證券交易所代碼:CVS)股價上漲3%。Cristna(CI)股價上漲1%,而Centene(NC)股...
4/7,美国联邦医疗保险和医疗补助服务中心 (CMS) 周五宣布,不会最终确定一项扩大Medicare和Medicaid计划对减肥药覆盖范围的提案,这将扭转拜登总统任期最后几个月提出的一项计划,该计划原本可以帮助数百万美国人支付昂贵的药物费用。 CMS 发言人表示,该机构认为扩大范围“目前不合适”,但他补充说,在仔细研究了这些药物的...
CMS issues new ruling on Medicare TPMO requirements Half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, a number that hasdoubled since 2010. This growth is partly due to the extensive network of insurance agents, brokers, field marketing organizations, and le...
11/26,美国医疗保险和医疗补助服务中心(CMS)宣布,正在尝试将抗减重药物纳入Medicare Part D和Medicaid范围,该计划于11月26日公布。根据2026年合同年度MA和Part D提案规则,CMS选择遵循传统医学观点,认为肥胖是一种疾病。因此,该机构能够重新解释一项排除减肥药物覆盖
The article reports the changes made by the Centers for Medicare & Medicaid Services (CMS) to the Home Health Prospective Payment System (HH PPS) rates in calendar year (CY) 2012, and highlights the decrease that is expected in payments to home health agencies (HHAs) in the calendar year....
4月4日,美国医保局(CMS)发布了2025年的Medicare Advantage和Medicare Part D的最终版规则,其中对生物类似药替代的要求明显降低,Medicare Part D的所有生物类似药替换不再明确要求CMS的提前批准,而此前这一原则仅适用于可互换的(interchangeable)生物类似药。在此之前
utilization management (UM) techniques adopted by MA plans, including requirements for such plans to conduct and report detailed analyses on the use of prior authorizations. Notably, the Proposed Rule primarily modifies MA regulations, without direct application to the Medic...
请问大佬,您说的联邦医保是CMS (Centers for Medicare & Medicaid Services) 吗? CMS官网是这么写的: CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children'sHealth InsuranceProgram, and the Health Insurance Marketplace. CMS works in ...