CMS Announces New Model to Reduce Unnecessary Emergency Department Use

Julie CarterMedicare Watch0 Comments

Source: Pixabay.com/ArtisticOperations

Today, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced a new model within traditional Medicare that could help people with Medicare avoid unnecessary trips to the Emergency Department. This new model would allow emergency transportation services to take individuals to their primary care doctor or urgent care, or to deliver treatment in place, when the person does not need to be seen in an emergency room. Read More...

Legislative Outlook for Health Care Issues in 2019

Lindsey CopelandMedicare Watch0 Comments

When the 116th Congress convened in January, it ushered in a dramatic shift in political dynamics. For the first time in eight years, Democrats have a majority in the U.S. House of Representatives. With Republicans still in control of the U.S. Senate, the two chambers of Congress will be divided for at least the next two years. Under split-party control, legislation will require bipartisan support in order to pass. The need for this agreement greatly, if temporarily, blunts the acute legislative threats to Medicare, Medicaid, and the Affordable Care Act (ACA) that dominated the last Congress. With extensive program overhauls unlikely to succeed this year, we expect lawmakers to instead focus on areas of shared consensus and concern. This includes “must-pass” items, like expiring health care programs, as well as those that are a top priority for both chambers, such as high prescription drug prices. Read More...

Medicare Rights Comments on CMS Proposal to Give Drug Plans Additional Flexibility

Lindsey CopelandUncategorized0 Comments

The Medicare Rights Center recently responded to a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would, in part, allow Part D and Medicare Advantage (MA) prescription drug plans greater flexibility in managing their formularies. According to CMS, the proposed policies are intended to “remove administrative hurdles to offer lower cost options to seniors and provide support for private sector partners by providing them the tools to lower the cost of prescription drugs.” While we agree with the need to address high and rising drug prices, we strongly disagree with the agency’s proposed approach, which seeks to do so by weakening the protected classes protections and permitting step therapy for Part B drug coverage. Such changes have the dangerous potential to disrupt or even end access to some medications for people with Medicare. Read More...

Cardiovascular Preventive Medicine Saving Lives and Saving Medicare Money

Julie CarterMedicare Watch0 Comments

Edwin Verin/Shutterstock.com

Though it’s well known that preventive care can improve health and save lives, establishing that preventive care can also save money has been more difficult. Until now, researchers have consistently found that preventive services do not end up saving money in the long term, but a new study shows that cardiovascular treatment seems to be the exception. Read More...

KFF Brief Highlights Financial Burden of Part D Specialty Drugs

Lindsey CopelandMedicare Watch0 Comments

Source: Kaiser Family Foundation

While Medicare Part D has made prescription drugs more affordable for people with Medicare, many beneficiaries continue to face affordability challenges, in part because there is no hard cap on out-of-pocket spending under Part D. A new resource from the Kaiser Family Foundation examines the financial burden this places on Part D enrollees who rely on high-cost medications. Read More...