Legislation & Regulation

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) finalized its rule for the 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP).

On Nov 1, The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare Prescription Drug Benefit Program (Part D).

On Nov 1, 2018 CMS issued a proposed rule that updates Medicare Advantage (MA) and Medicare Part D Programs. The proposed rule would allow MA plans to offer “additional telehealth benefits”, makes changes to dual-eligible special needs plans, would allow Part D plans to request standardized extracts of Medicare claims data about its plan enrollees, and proposes enhancements to star ratings.

AMCP webinar that reviewed AMCP’s activity related to preapproval information exchange (PIE) and provided the payer and manufacturer perspective on the important and usefulness of PIE.

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

AMCP sends letter of concern for needed provisions in the Senate amendment in the nature of a substitute of H.R. 6 to Senate leadership and the Chairs and Ranking Members of HELP, Finance, Judiciary, and Commerce committees

On August 7, 2018, CMS issued guidance to Medicare Advantage (MA) plans acknowledging that step therapy is a recognized utilization management tool. CMS stated that the allowance of step therapy practices for Part B drugs will help achieve the goal of lower drug prices while maintaining access to covered services and drugs for beneficiaries. MA plans will have the choice of implementing step therapy to manage Part B drugs, beginning January 1, 2019.

AMCP comments on state legislation on e-prescribing.