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...
As Medicare Advantage premiums remain generally stable, more than 1,500 plans representing 8.7 million beneficiaries will participate in the CMS Innovation Center’s Medicare Advantage Value-Based Insurance Design (VBID) Model in 2024. The model improves access to supplemental benefits th...
On November 26, 2024, Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule revising the Medicare Advantage (“MA”) Program (Part C), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-...
For Medicare Advantage plans, the average monthly premium will decrease from $18.23 in 2024 to $17 in 2025, continuing a trend of declining premiums over recent years, said CMS. This reduction, the agency said, reflects not only its payment policy updates, but also the sustained competit...
CMS reins in Medicare Advantage plansis a new online resource designed to meet the evolving needs of physicians. It brings together elements from Advanstar's trusted healthcare journals along with powerful tools, resources, decision support and advisory functions.Reid Paul...
On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule with technical changes for the Medicare Advantage (MA) Program and the Medicare Prescription Drug Benefit Program for Calendar Year 2026 (Proposed Rule). Citing the growing ...
CMS Finalizes New Medicare Marketing Requirements The U.S. Centers for Medicare and Medicaid Services (CMS) issued afinal ruleon April 5, 2023, revising the regulations governing marketing by Medicare Advantage plans (MAPs) and Medicare Part D plans (PDPs). These changes follow CMS’s...
To give just one example, this August, it was reported that “CMS dropped a proposed regulation that would have required Medicare Advantage plans to return overpayments found during chart reviews over industry opposition.” The “industry,” with its deep pockets, has been fighting this proposed ...
Medicare Advantage Plans Onerous Prior Authorizations Requirements & Negative Impacts on Skilled Nursing Facilities Stotler Hayes Group, LLCon2/17/2025 Traditional Medicare (Parts A and B) and Medicare Advantage (Part C, including additional vision, dental, and hearing benefits) plans aim to provide ...
Advantage spaces, which has been a hot-button issue in 2023 and 2024. Major payers have been accused ofusing AI tools to increase claim denials. In light of these controversies, the proposed rule would require Medicare Advantage health plans to confirm that their use of AI upho...