Topic: Brain Food

Narrow Networks 2017: Will Narrow Pharmacy Networks Evolve from Reduce-Reimbursement to Performance Networks?

Wayne Miller

Part D Sponsors to the Medicare Part D program must ensure that their retail pharmacy networks meet the convenient access criteria established under 42 CFR §423.120. These metrics stem directly from the statutory requirement that Medicare Part D sponsors’ entire retail pharmacy networks meet the TRICARE standard for convenient access: Sponsors and applicants must ensure that their networks have a sufficient number of pharmacies able to dispense drugs directly to patients (other than by mail order) to ensure convenient access to Part D drugs. CMS rules require that sponsors establish retail pharmacy networks in which: Read more

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Are You Ready for the Medicare Advantage Advance Notice & Draft Call Letter?

Olga Walther

As you may recall, in December 2015, the Securing Fairness in Regulatory Timing Act extended the 45-day notice period for the Medicare Advantage Advance Notice & Draft Call Letter (draft call letter). This means the industry now has 60 days to review the proposed payment and benefit changes, getting a few more weeks to digest the minutiae of the draft call letter. It also means we are now expecting the draft call letter to come out on February 1, earlier than the typical mid-February release.

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Marketing and Sales Return on Investment (ROI) – What Is the Data Telling You?

Carrie Barker-Settles

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Opportunities for Growth in the New Administration

Diane Hollie

“Opportunities are like sunrises. If you wait too long, you miss them.” ―William Arthur Ward 

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The Trump De-Regulators and Medicare Advantage

Steve Balcerzak

Hmm, you’re asking what will the Trump de-regulators do to Medicare Advantage? Given the confusion about ObamaCare non-replacement for three years and the selection of a Medicaid maven for Administrator, we haven’t heard much about Medicare Advantage and Part D. However, Trump said he wants a list of wasteful and unnecessary regulation. Even with that, we may not see a lot of actual regulatory change during 2017 in either of these programs. Changing regulations in a major way takes too much time to propose, review, and finalize anything of substance in a short period. However, there are other actions the new Administrator can take. First and foremost, de-regulators are interested in slowing the process or moderating its effects, so here are some potential actions.

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New Year. New Congress. New Administration. Same old healthcare, for now.

Olga Walther

Despite the Trump administration having yet to take office, Congress kept its promise to get the Affordable Care Act (ACA) repeal ball rolling on day one. On January 3, 2017, the first day back for Congress, the chair of the Senate’s Budget Committee introduced a budget resolution that directs several committees in both the House and Senate to begin work on the ACA repeal.  Specifically, the resolution calls for the committees to submit recommendations to reduce the deficit by $1 billion in the next decade. So what happens next?

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2017: Taking Stock to Inform Next Steps

Regan Pennypacker

As the end of 2016 approached, it made for a good time to look back on developments that have impacted us over the past year. The most impactful changes related to 2016 decisions are to come, however, a few important lessons learned over the past year are worth additional reflection. This is especially true if you believe in the effects of Mercury in retrograde. Read more

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