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,任何生物药处方的变更中,CMS规定保险公司、PBM或...
Ahead of the Medicare Open Enrollment Period, CMS hasannouncedthat Medicare Advantage premiums, benefits, and plan choices will remain relatively stable in 2024. “A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare, their children, and ...
AI and other algorithms can be used as part of making Medicare Advantage coverage decisions. CMS reminds Medicare Advantage organizations that coverage must be based on individualized determinations. AI and other algorithms should not perpetuate or create discriminatory and biased res...
Anne W. Hance
“MCMG”), which provide guidance and examples on what qualifies as marketing material, the procedures for sponsors to submit those marketing materials, and the proper use of marketing materials.1When contacting Medicare beneficiaries, plans and sponsors must submit marketi...
Traditional Medicare (Parts A and B) and Medicare Advantage (Part C, including additional vision, dental, and hearing benefits) plans aim to provide comprehensive medical benefits to American Seniors and adults with...more The Federal Funding Freeze and its Effect on Health Equity Programs ...
“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,”saidCMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger...
The federal government said it is giving Medicare Advantage plans the ability to require step therapy for Part B drugs, labeling it as a way to drive down drug costs by motivating pharmaceutical companies to come to the negotiating table. ...
CMS released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.
CMS is expanding coverage for benefits that address social determinants of health, creating savings opportunities for payers and broadening opportunities for new entrants to healthcare. Medicare Advantage plans in 2019 will be able to provide coverage for a wider variety of non-medical...