Newsletters

08.22.24

CMS Opens Funding Opportunity for States to Participate in Cell and Gene Therapy Model

On August 15, the Centers for Medicare & Medicaid Services (CMS) released a Notice of Funding Opportunity (NOFO) for states participating in the Cell and Gene Therapy (CGT) Access Model.


08.22.24

Maryland PDAB Releases Draft Upper Payment Limit Action Plan

On August 9, Maryland’s Prescription Drug Affordability Board (PDAB) released its draft action plan for establishing upper payment limits (UPLs) for drugs identified as causing or likely to cause affordability challenges.


08.22.24

The Inflation Reduction Act Infographic: Overview of Announced Drug Prices

On August 15, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the “maximum fair prices (MFPs)” for the first 10 drugs subject to the Medicare drug negotiation program. 


08.20.24

The End of Provider Pooling? What Providers and States Need to Know about CMS’ Recent Regulations

CMS recently reinforced its commitment to prohibiting pooling arrangements. Given CMS’s position, provider groups with pooling arrangements will want to consider alternative approaches.


08.14.24

States Challenge CMS Rule Making DACA Recipients Eligible for Marketplace Subsidies

On August 8, a coalition of 15 state attorneys general sued CMS in the North Dakota federal court seeking to overturn a May 2024 CMS final rule making Deferred Action for Childhood Arrivals (DACA) recipients eligible for premium tax credits on the Marketplace.


08.13.24

Five Things to Watch When First “Maximum Fair Prices” for Selected Drugs Announced

The Centers for Medicare & Medicaid Services (CMS) is required to make public by September 1 the “maximum fair prices” (MFP) that CMS is setting for the first ten drugs subject to the Medicare Drug Price Negotiation Program (Negotiation Program) under the Inflation Reduction Act of ...


08.07.24

CMS Approves North Carolina’s Plan to Incentivize Medical Debt Relief

On July 26, CMS approved North Carolina’s plan to condition enhanced Medicaid payments on hospitals’ participation in a statewide medical debt relief policy initiative.


08.07.24

CMS Announces Part D Premium Parameters, New Policy to Stabilize Standalone Part D Premiums

The Centers for Medicare & Medicaid Services (CMS) released the Part D national average bid amount and Part D base beneficiary premiums for 2025.


08.07.24

340B Hospitals Sue HRSA for Authorizing Audits of 340B Records

On July 24, two hospitals that participate in the Section 340B drug discount program—Oregon Health & Science University and Maine General Medical Center—filed separate lawsuits against the Health Resources and Services Administration (HRSA), alleging that HRSA had unlawfully ...


08.07.24

Proposed Medicare Physician Fee Schedule Would Extend Telehealth Flexibilities and Add New Coverage

The Centers for Medicare & Medicaid Services (CMS) released its annual proposed rule updating the Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2025.