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Part D Payer Shares of Prescriptions Dispensed Rise

6 Responses

1. Mark, on March 27, 2010 at 11:33 AM said:

   The Wall Street Journal has found another potential bonus for big-pharma in healthcare reform: closing of the doughnut hole.

   http://online.wsj.com/article/SB10001424052748704094104575143961683850340.html?mod=googlenews_wsj

   Mark

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2. Gil, on April 20, 2010 at 10:15 AM said:

   Aetna – I’m Glad I Never Met Ya!

   The Centers for Medicare & Medicaid Services has issued an intermediate sanction against the Aetna Insurance Company for what CMS officials said are violations in administering the Medicare drug benefit.

   http://www.healthcarefinancenews.com/news/cms-issues-sanctions-against-aetna

   Gilbert

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3. Shane, on May 5, 2010 at 8:48 AM said:

   More on Medicare Part D

   Medicare’s drug benefit became available in 2006 through a variety of private plans. Some plan types were new (stand alone prescription drug plans (PDPs) and regional PPOs) and some were familiar (local Medicare Advantage (MA) plans).

   Steve Pizer and Austin Frakt published the first peer-reviewed paper characterizing the forms the drug benefit took under the variety of plan types ”A First Look at the New Medicare Prescription Drug Plans,” Health Affairs Web Exclusive (May 23, 2006): w252-w261.

   It is worth a review after healthcare reform.

   http://theincidentaleconomist.com/a-first-look-at-the-new-medicare-prescription-drug-plans-frakt-pizer-2006/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheIncidentalEconomist+%28The+Incidental+Economist+%28Posts%29%29

   Shane

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4. Ann Miller RN MHA, on January 8, 2012 at 12:22 PM said:

   eRx Penalty Revealed in Fine Print of Medicare Remittances

   Physicians who wonder whether they received a hardship exemption from Medicare’s 1% penalty in 2012 for failing to e-prescribe in 2011 will have to find out by reading the fine print on their payment remittance statements. The Centers for Medicare and Medicaid Services (CMS) had intended to inform physicians and other prescribers whether they would be subject to the penalty through a feedback report that they could access online. However, on December 29, the agency announced that “due to the high volume of significant hardship exemption requests, it is no longer technically feasible for CMS to provide a…feedback report.”

   Instead, CMS encouraged prescribers to check their remittance statements for claims submitted for services rendered since January 1, 2012. If they were hit with the 1% penalty (a “payment adjustment” in CMS parlance), they would see the letters “LE” on the statement and 2 different codes. The first is Claim Adjustment Reason Code (CARC[I1]) 237, indicating a “legislated/regulatory penalty.” The second is Remittance Advice Remark Code (RARC) N545, which explains that the provider was an “unsuccessful e-prescriber” in 2010 as defined by Medicare’s e-prescribing incentive program.

   Source: Robert Lowes, Medscape News [1/5/12]

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5. Eray, on December 21, 2013 at 11:24 AM said:

   ‘Let the Crime Spree Begin’
   [How Fraud Flourishes in Medicare’s Drug Plan]

   The federal government does little to stop schemers from stealing from Medicare Part D, the program that provides prescription drugs to more than 36 million seniors and disabled people.

   http://www.propublica.org/article/how-fraud-flourishes-in-medicares-drug-plan?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

   Eray

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6. Hope R. Hetico RN MHA, on December 1, 2014 at 8:34 PM said:

   CMS – Key Changes and Updates Finalized in the 2015 Rate Announcement and Final Call Letter for Medicare Advantage and Prescription Drug Benefit (Part D) Programs

   1. Lower Out-of-Pocket Drug Spending: Beneficiaries in the Part D prescription drug coverage gap, or “donut hole,” will benefit from greater savings on prescription drugs
   2. Greater Protection for Beneficiaries: CMS intends to again use its authority to protect Medicare Advantage enrollees from significant increases in costs or cuts in benefits
   3. Increased Protections for Beneficiaries Affected by Changes in Medicare Advantage Plan Networks: Strengthens tools used to ensure compliance with established provider access requirements
   4. Payments to Medicare Advantage Plans: CMS estimates that the overall net change to plan payments between 2014 and 2015 to be +0.4 percent.

   Source: Centers for Medicare & Medicaid Services

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