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Medicare Part D Protected Classes Targeted in Last-Minute Payment Demo Update

 
• By Cathy Kelly

If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.

Protected Classes Policy Is Unique To Medicare Part D

The Centers for Medicare and Medicaid Services announced on the final day of the Trump Administration that it would allow insurers participating in the Medicare Part D payment modernization model to restrict coverage in the six protected classes, in an attempt to attract more volunteers to the demonstration.

Under an eleventh-hour update to the model released on 19 January, CMS announced it would waive the requirement that...

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• By Lisa Takagi

While the adoption of most favored nation drug pricing in the US stands to affect Japanese biopharma firms now heavily reliant on this market, it might also present an opportunity for pricing and policy reforms at home.

Payment Cap Not Always Solution For Unaffordable Drugs, Maryland PDAB Director Says

 
• By Cathy Kelly

The state's Prescription Drug Affordability Board, the oldest of a growing list of the boards, chose six drugs for affordability reviews and has the authority to set a ceiling on the amount state and local government payers would reimburse for them.

Saving Part D: US Medicare Advisors Sound The Alarm

 
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The US Medicare Payment Advisory Commission worries that Medicare prescription drug market trends may cause the stand-alone plan portion of the program to “wither away,” which could take the traditional fee-for-service side of Medicare with it.