Medicare

Pharmacist
Resource

Contract Year (CY) 2026 Medicare Part D Opioid Safety Edits – Submission Instructions, Recommendations, and Reminders

Medicare Part D sponsors must have concurrent drug utilization review (DUR) systems, policies, and procedures designed to ensure that a review of the prescribed drug therapy is performed before each prescription is dispensed to an enrollee in a sponsor’s Part D plan, typically at the POS or point of distribution as described in 42 CFR § 423.153(c)(2).
Medicare
Capitol Hill, U.S. Capitol, IRA Workshop
Letters, Statements & Analysis

AMCP Comments on the 2025 Medicare Physician Fee Schedule

On September 9, AMCP submitted comments praising CMS’s proposal to cover Digital Mental Health Treatment devices (DMHTs) under Medicare Part B. AMCP urges CMS to use its authority to cover all FDA-cleared, prescription only digital health products and develop appropriate coding and payment methodologies to promote adoption of these innovative technologies.
Medicare
Resource

AMCP Submits Comments to CMS on Medicare and Medicaid Programs; Regulation to Require Drug Pricing Transparency

On January 25, 2019, AMCP provided comments to CMS in response to its proposed rule on lowering drug prices and reducing out-of-pocket expenses in the Medicare program. The letter outlines the proposal’s impact on providing plan flexibility to manage protected classes, prohibition against gag clauses in pharmacy contracts, E-Prescribing and the Part D Prescription Drug Program, Part D explanation of benefits, and Medicare Advantage and step therapy in Part B.
Legislation & Regulation, Fraud, Waste and Abuse, Medicare, Price Transparency, Medicaid, Medicare Part D
Press Releases

JMCP Research Highlight: Disability Drives High Prevalence of Opioid-Related Disorders in the Medicare Fee-for-Service Population

Press Release: The prevalence of those diagnosed with opioid-related disorders in the Medicare fee-for-service (FFS) population is higher than among any other studied payer groups, and the majority of disorders were found among those receiving Medicare based on disability.
Medicare, Legislation & Regulation, Real World Evidence & Research