Are you confident in your current process to review and identify non-compliant rejected claims? Rejected…
Part D Benefit Administration Impacts Audit Experience
In the newly released 2018 Part C and D Program Audit and Enforcement Report, CMS…
Indication-Based Formularies Are Coming in 2020
Change is in the air. Recently, the Centers for Medicare & Medicaid Services (CMS) announced…
CMS Releases a Policy Statement of Pharmacy Network Gag Clauses
A bipartisan group of U.S. senators introduced legislation on Wednesday, March 14, that would prohibit…
2018 Part D Tiering Exception Rule Changes
Among multiple policy changes to the 2018 Prescription Drug Benefit Program proposed, the Centers for…
A Decade of Lagging Medicare Part D MTM Services
After a decade of Medication Therapy Management (MTM) programs, nearly every Medicare Advantage plan still…
Narrow Networks 2017: Will Narrow Pharmacy Networks Evolve from Reduce-Reimbursement to Performance Networks?
Part D Sponsors to the Medicare Part D program must ensure that their retail pharmacy…
Part D Benefit Administration Continues to be Important Monitoring for CMS
Your Pharmacy Benefit Manager (PBM) may have already provided to you their benefit testing pan…
Keep the End in Mind as 2017 Readiness Approaches
According to Author Stephen Covey, in his book The Seven Habits of Highly Effective People,…
Changes for 2015 Part D Reporting Announced by CMS
The Centers for Medicare & Medicaid Services (CMS) recently released an updated version of the…