A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
Q: If a patient participating in a clinical trial is allergic to one of the drugs used in the trial, how do we report the drug that is used as a substitute?
This week’s Medicare updates include a proposed rule regarding changes to the Medicare Advantage program regulations and Prescription Drug Benefit program, a review of hospital wage data to determine vulnerabilities in the hospital wage index system, the Fall 2018 semiannual report to Congress, and more!
Along with E/M changes for 2019 and beyond, the 2019 Medicare Physician Fee Schedule final rule contains a plethora of regulations impacting reimbursement, including new modifiers for therapists.
Despite facing potential lawsuits and political opposition, CMS finalized some of its most controversial proposals in the 2019 OPPS final rule by implementing several site-neutral payment policies and 340B drug payment reductions.
