Since the IRA went into effect in August 2022, manufacturers have struggled to understand exactly how the significant Part D benefit redesign and the resulting shift in expenditure between CMS, payers, manufacturers, and patients would impact manufacturer liability, payer coverage decisions, and contract negotiations. Here are 5 things you should be thinking about regarding Part D redesign and the upcoming 2026 bid cycle: 1) Payer economics of individual brands may vary based upon phase in eligibility 2) Dynamics within LIS and non-LIS require careful evaluation 3) Consider your multi-year bid strategy as phase in schedule changes yearly through 2031 4) Rebate dollars will become more valuable as payers are expected to retain a higher percentage of DIR in the years ahead 5) CMS’ expenditures in catastrophic coverage will decline but their direct subsidies to plan are expected to increase substantially Learn More: https://lnkd.in/dUiREnQW
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Since the IRA went into effect in August 2022, manufacturers have struggled to understand exactly how the significant Part D benefit redesign and the resulting shift in expenditure between CMS, payers, manufacturers, and patients would impact manufacturer liability, payer coverage decisions, and contract negotiations. Here are 5 things you should be thinking about regarding Part D redesign and the upcoming 2026 bid cycle: 1) Payer economics of individual brands may vary based upon phase in eligibility 2) Dynamics within LIS and non-LIS require careful evaluation 3) Consider your multi-year bid strategy as phase in schedule changes yearly through 2031 4) Rebate dollars will become more valuable as payers are expected to retain a higher percentage of DIR in the years ahead 5) CMS’ expenditures in catastrophic coverage will decline but their direct subsidies to plan are expected to increase substantially Learn More: https://lnkd.in/dUiREnQW
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If your organization is impacted by the Part D benefit redesign, we're here to help! You may find more information on key considerations below. #IRA #pharma #PartD
Since the IRA went into effect in August 2022, manufacturers have struggled to understand exactly how the significant Part D benefit redesign and the resulting shift in expenditure between CMS, payers, manufacturers, and patients would impact manufacturer liability, payer coverage decisions, and contract negotiations. Here are 5 things you should be thinking about regarding Part D redesign and the upcoming 2026 bid cycle: 1) Payer economics of individual brands may vary based upon phase in eligibility 2) Dynamics within LIS and non-LIS require careful evaluation 3) Consider your multi-year bid strategy as phase in schedule changes yearly through 2031 4) Rebate dollars will become more valuable as payers are expected to retain a higher percentage of DIR in the years ahead 5) CMS’ expenditures in catastrophic coverage will decline but their direct subsidies to plan are expected to increase substantially Learn More: https://lnkd.in/dUiREnQW
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Did you miss our live webinar covering the complex components of the Medicare Prescription Payment Plan (M3P)? It’s now available on demand. Watch now and download an M3P checklist to discover what program means for plan performance: https://lnkd.in/geiksKCC
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Assistant Manager Operations at CloudRCM Solutions | AR Specialist | RCM Specialist | CRM Expert | Reporting Expert | MS Office Specialist | Auditor | Proficient in Using Softwares | Plan Maker | Negotiation Specialist.
Difference Between CPID and Payer ID Purpose CPID: Identify the payer for electronic claims processing. Payer ID: General identifier for healthcare payers. Assigned By CPID: Clearinghouse. Payer ID: Varies. Format CPID: Typically a 4- or 5-digit number. Payer ID: Can vary in length and format. Usage CPID: Electronic claims processing. Payer ID: Manual claims processing, looking up payer information.
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Did you know that CMS is looking for feedback on how to operationalize the IRA negotiated price in the supply chain? The new Request for Information is an opportunity for stakeholders to help shape the potential role of a new entity, the Medicare Transaction Facilitator, charged to verify that only MFP-eligible individuals get access to the negotiated price to avoid diversion. Avalere is helping clients respond to the RFI, but also refine their business strategy around a number of open questions related to 340B discount non-duplication, patient cost-sharing, provider and pharmacy reimbursement, role of PBMs, etc. How the MFP is effectuated in the market is the question that will ultimately determine the administrative and financial burden for various players in the market. Reach out to learn more #avalere #IRA #Medicare #MFP #MTF Kelsey Lang Clayton Keene J. Lance Grady Omar Hafez
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I hear a lot of EMS leaders calling for payers (usually CMS) to increase their reimbursement rates. I rarely hear these leaders explaining how they will return increased value to payers in return. From my vantage point, it seems like public and private payers alike are very cost sensitive, so simply saying "we need more money because our expenses have increased" does not seem like a winning strategy.
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Transparency Reporting made EASY | Sunshine Act | CMS Open Payments | Pharmaceutical and Medical Device
I have been chatting with a few newly applicable manufacturers who were surprised to here they did not have to report 2023 transactions to the Govt (𝐚𝐥𝐭𝐡𝐨𝐮𝐠𝐡 𝐭𝐡𝐞𝐲 𝐰𝐨𝐮𝐥𝐝 𝐡𝐚𝐯𝐞 𝐬𝐭𝐚𝐭𝐞 𝐫𝐞𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐫𝐞𝐬𝐩𝐨𝐧𝐬𝐢𝐛𝐢𝐥𝐢𝐭𝐢𝐞𝐬). Because of this, I thought I would highlight the CMS Open payments FAQ to provide some light. Fundamentally, you have 180 days to get your act together 🤣 Question: When an entity with no covered products becomes an applicable manufacturer or applicable group purchasing organization (GPO) because payment becomes available for one of the company’s products under Medicare, Medicaid, or CHIP (for example, because a manufacturer’s only product received FDA approval), must the entity report payments or other transfers of value previously made to physicians and teaching hospitals? Answer: When an applicable manufacturer or applicable GPO that did not previously have any other covered products becomes subject to the Open Payments data collection and reporting requirements, they will be granted a grace period of 180 days following a product becoming ‘‘covered’’ to begin complying with the data collection and reporting requirements. Therefore, retroactive reporting is not required.
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Did you know only 58% of providers review their payer contracts yearly, and 17% report never reviewing them? Providers need to know their contracts and know what is and is not working for their organization. On the other hand, payers must also ensure they are up to date on their contracts and can supply providers with accurate information and data throughout the negotiation process. As the payer/provider battle rages on, make sure you're prepared. Read all about it in our March cover story. #payers #provider #contracts https://lnkd.in/g6hPZUF4
Payers and Providers Are Fighting. 3 Ways to Win.
interactive.healthleadersmedia.com
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We like to provide #OPTIONS (#MedicareAgent) for our agents that are in the Medicare business. Options like how would you like to enroll your client for Medicare advantage or a drug plan? What would your client prefer? A clean fillable PDF, a text enrollment for MA/PDP and everything in between…Are you limiting your client to one option? We like to provide our agents and as a result their clients numerous options on how to receive quotes, facilitate enrollments and pertinent documents. Speaking of documents, what do you do when you’re in a last-minute jam to get a application or carrier form right at AEP when you don’t have supplies? We have a comprehensive forms library that has every one of our carrier partners documents for every state, city and county in the country. Does Your FMO/Upline give you these kinds of options? Call or email me to find out more about these options. 402-343-3641 or mlube@seniomarketsales.com #Broker #Independentbroker #Medicareagent #Medicareadvantage #Medicaresupplement #OneofManyExamples
Sales Tools | Senior Market Sales
seniormarketsales.com
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Hospital Indemnity Plans (HIP) cover hospital stays, medical services, and related expenses not covered by Medicare, complementing Medicare Advantage (MA) plans well. This has led to increased awareness and sales among distributors and seniors. Based on Telos Actuarial, LLC, new business premiums for senior HIP products have grown significantly since 2019, with lower-than-expected loss ratios. With the expanding popularity of MA products, this trend in senior HIP growth is likely to continue. Read the full report here: https://lnkd.in/gf8zpSBM
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