Legislation & Regulation

Discover essential legislative and regulatory resources tailored for managed care pharmacy professionals. Stay informed with the latest updates, policies, and advocacy tools to effectively navigate and influence the health care landscape.

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AMCP Submits Comments to CMS on Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Call Letter

On March 1, 2019, AMCP provided comments to CMS in response to its 2020 for Medicare Part D Call Letter. AMCP offered comments on the following sections of the notice; Part D Benefit Parameters for Non-Defined Standard Plans; Formulary Submissions; Medication Therapy Management (MTM); and Part D Mail Order Auto-Ship Modifications.
Legislation & Regulation, Medicare Part D, Medication Therapy Management (MTM)

AMCP Summary: Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain POS Reductions in Price on Prescription Pharmaceuticals

On January 31, 2019, HHS proposed sweeping changes to the current system for medication pricing and contracting by PBM companies in federal programs. This summary reviews OIG's proposal to eliminate the safe harbor protections for rebates that exist in the federal Anti-Kickback Statute (AKS) and replace these protections with proposed new safe harbors allowing for point-of-sale discounts to beneficiaries and for manufacturer-paid service fees to PBMs.
Medicaid Managed Care, Medicare Part D, Rebates, Legislation & Regulation