On November 1, 2018, CMS finalized its rule for the 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP). In the final rule, CMS acknowledges responses to its comment solicitation in the proposed rule on creating a bundled episode of care for management and counseling treatment for substance use disorders. Additionally, CMS is implementing a provision from the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act through an interim final rule. The Final Rule also reduces wholesale acquisition cost (WAC)-based payment for newly-launched physician-administered drugs to 103% of WAC.
On October 18, 2018, CMS issued a new proposed rule that would require direct-to-consumer (DTC) television advertisements of prescription drugs and biological products payable by Medicare or Medicaid to include the wholesale acquisition cost (WAC), or list price, of that prescription drug or biological product.
AMCP letter to Congressional Leadership asking for the inclusion of 42 CFR Part 2 provisions and Medicare fraud, waste and abuse protections in a final opioid conference report
On September 10, 2018, AMCP submitted comments to CMS on its proposed revisions to the 2019 Physician Fee Schedule. While AMCP believes that a bundled episode of care payment is a step in the right direction to ensure patients with SUDs have access to care, AMCP provided CMS with several recommendations to consider when developing a formal proposal.
AMCP CEO Blog: One of AMCP’s key strategic pillars is to advocate for legislation that will help advance the profession of managed care pharmacy. This function is on full display this week during our Annual Legislative Days event.