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Medicare Advantage Prior Authorization and Step Therapy for Part B Drugs

Today, the Centers for Medicare & Medicaid Services (CMS) introduced much-needed competition and negotiation into the market for physician-administered and other Part B medications that will result in better deals and lower drug costs for patients. As part of the agency’s ongoing activities to deliver on President Trump’s promises outlined in his American Patients First Blueprint, CMS will provide Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs in a way that lowers costs and improves the quality of care for Medicare beneficiaries.
Fact sheet

CMS empowers patients with more choices and takes action to lower drug prices

Agency is providing flexibility through private sector tools to negotiate lower prescription drug prices on behalf of beneficiaries.
Press release

SPEECH: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, DC

(As prepared for delivery – August 6, 2018)
Press release

Medicare Part D premiums continue to decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline.
Press release

Speech: Medicare Remarks by CMS Administrator Seema Verma at the Commonwealth Club of California

I’d like to talk to you about things on which we all agree, like the future of our healthcare system, and Medicare. And if we have time we can touch quickly on world peace before we all leave.
Press release

The Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration

CMS is announcing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. The MAQI Demonstration will be tested under the authority of Section 402 of the Social Security Amendments of 1967 (as amended).
Fact sheet

CMS Takes Action to Modernize Medicare Home Health

Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care.
Press release

CMS Advances Demonstration to Waive MIPS Requirements for Clinicians in Certain At-Risk Medicare Advantage Plans

Today, the Centers for Medicare & Medicaid Services (CMS) is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk.
Press release

Medicare Trustees Report shows lower spending projections for Medicare Part D

Today, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds -- the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund.
Press release

CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

Today, the Centers for Medicare & Medicaid Services sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs.
Press release