CMS — Lanton Law Blog

CMS Makes An Impactful Change Regarding Biosimilars

Within its final calendar year 2025 Medicare Advantage and Part D final rule seen here, the Centers for Medicare and Medicaid Servces (CMS) is allowing Part D sponsors the ability to make midyear substitutions of biosimilars for their reference products on their formularies.

biologics, Biosimilars, biotechnology, biotech, healthcare, insurance, pharmaceuticalsRon LantonApril 8, 2024biosimilars, CMS, Centers for Medicare and Medicaid Services, insurance, healthcare

Biden Administration Announces First Ten Drugs Selected for Medicare Price Negotiation

The Biden Administration has announced today that Medicare will be able to negotiate drug prices for the first time due to provisions within the Inflation Reduction Act.

healthcare, life sciences, Medicare Part D, pharmaceuticals, prescription drug costsRon LantonAugust 29, 2023Inflation Reduction Act, drug prices, pharmaceuticals, prescription drug prices, Medicare Part D, CMS, HHS

What is Remote Patient Monitoring (RPM)?

Remote patient monitoring is an innovative way that healthcare providers are using to treat chronic and acute conditions. With COVID-19 spurring faster adoption of telehealth and RPM, the subject of RPM involves the connection of digital tools that record healthcare data that is reviewed by an off-site provider.

remote patient monitoring, HealthIT, healthcare, HHS, Digital Therapeutics, digital healthRon LantonFebruary 27, 2023RPM, RTM, digital therapeutics, Telehealth, telemedicine, digital health, CMS

Prescription Digital Therapeutics Bill Introduced in Congress

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act also known as S. 5238 seen here was introduced on December 12, 2022 by Senator Capito (R-WV).

CMS, Congress, Digital Therapeutics, healthcare, HHS, HealthIT, legislation, pharmaceuticalsRon LantonDecember 27, 2022Medicaid and CHIP Access to Prescription Digital Therapeutics Act, digital therapeutics, remote patient therapy, remote patient monitoring, CMS, Medicaid, CHIP, prescription

CMS is Proposing to Delay the Radiation Oncology (RO) Model

Last week the Centers for Medicare & Medicaid Services (CMS) announced its proposal to delay the start of the Radiation Oncology Model. The announcement can be found here. No reason was given but the proposed reimbursement structure was undoubtedly the major reason behind this delay.

healthcare, life sciences, pharmaceuticals, oncology, reimbursementRon LantonApril 13, 2022CMS, Centers for Medicare & Medicaid Services, Radiation Oncology Model, radiotherapy, bundled payment, Site Neutrality

Prescription Digital Therapeutics Presses Ahead for Behavioral Health

At Lanton Law we have been monitoring the both exciting and emerging field of prescription digital therapeutics. While the technologies we have been witnessing are promising, there does remain the challenge of reimbursement, since there has not yet been a statutory benefit category established for this new technology. However; behavioral health shows the most immediate promise.

CMS Ends Most Favored Nation Drug Price Model Proposal

According to the Centers for Medicare and Medicaid Services (CMS), the agency has published a final rule in the Federal Register on December 27, 2021, that rescinds the November 27, 2020, MFN Model interim final rule with comment period. The final rule rescinding the Most Favored Nation Model interim final rule with comment period can be found here.

Biosimilars, biologics, CMS, healthcare, life sciences, reimbursementRon LantonJanuary 5, 2022Most Favored Nation, CMS, biologics

CMS Proposes Rescinding Most Favored Nation Interim Final Rule

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule that seeks to rescind the Most Favored Nation Model interim final rule with comment period that appeared in the November 27, 2020 Federal Register. CMS is seeking public comment by October 12, 2021.

CMS, healthcare, HHS, life sciences, Medicare, Medicare Part B, Medicare Part D, pharmaceuticals, pharmacy, prescription drug costs, Most Favored NationRon LantonAugust 10, 2021Most Favored Nation, CMS, Centers for Medicare and Medicaid Services, California Life Sciences, Regeneron Pharmaceuticals, healthcare, life sciences

Administrative Judge Rules Against Washington State’s Pharmacy Reimbursement Plan Violates Medicaid Rules

Last week the National Association of Chain Drug Stores (NACDS), the Washington State Pharmacy Association (WSPA) and the National Community Pharmacists Association (NCPA) celebrated an administrative law judge’s ruling against Washington State that stated Washington’s pharmacy reimbursement plan violated Medicaid’s rules.

CMS, healthcare, HHS, pharmacyRon LantonNovember 29, 2020Medicaid, Washington State, State Plan Amendment, Washington State Pharmacy Association, NCPA, NACDS, CMS

New Telehealth Legislation Introduced In the U.S. House of Representatives

Lanton Law has been monitoring the state and federal policy developments with telehealth/telemedicine. We have noticed a newly introduced Congressional bill that is on point.

CMS, HHS, telemedicine, telehealth, pharmacy, Medicare, HealthITRon LantonJuly 17, 2020Medicare, Telehealth, Telemedicine, CMS, COVID-19, Protecting Access to Post-Covid-19 Telehealth Act

CMS Star Ratings: Will Biosimilars Benefit?

The Centers for Medicare and Medicaid Services (CMS) star ratings system was created in 2007 for insurance plans operating under both the Medicare Advantage and Part D. This 1 to 5 system (with 5 being the highest rating) is a way for CMS to measure the value of a plan and determine whether to continue to allow it to be part of the program. However, it’s more than just the plan, since the plan’s providers play a key role in how CMS evaluates each plan.

Congress, CMS, healthcare, home infusion, life sciences, pharmacy, pharmaceuticalsRon LantonDecember 5, 2019CMS, Star Ratings, Congress