Changes to Medicare benefits in 2025 include an annual $2,000 cap on out-of-pocket costs for covered Part D drugs and a new, voluntary Medicare Prescription Payment Plan intended to help beneficiaries manage drug costs.
Joint Letter to CMS Advocates Against Adding Stelara to Self-Administered Drug List
The ACR, CSRO and Arthritis Foundation asked the Centers for Medicare & Medicaid Services to review the decision to add Stelara to the Self-Administered Drugs list, which would limit access for patients who can’t self-administer.
Off-Label Coverage of Mycophenolate for Scleroderma under Medicare Part D
Based on a request by the ACR Insurance Subcommittee, off-label use of mycophenolate for scleroderma has been added to a Medicare-approved compendium.
White House Preparing Order that Would Cut Drug Prices for Medicare
(Reuters)—U.S. President Donald Trump is considering a sweeping executive order that would cut prices on virtually all branded prescription drugs sold to Medicare and other government programs, according to two industry sources who had discussions with the White House. The order under discussion would be much broader than the Administration’s previously disclosed proposal to lower…
Drug Makers Met with Trump to Argue against Senate Pricing Bill
(Reuters)—The main pharmaceutical industry lobbying group said on Thursday it and some drugmakers met with President Donald Trump to voice opposition to a bipartisan U.S. Senate bill that aims to lower prescription drug prices. The White House, which has said it backs the legislation, has promised to bring down drug prices for U.S. consumers, an…
Reminder: How to Handle Part D Prior Authorization Requests
Note: Although originally posted in January 2018, the advice below remains valid. We see this issue recur each year. As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B,…
Medicare Changes Could Have Some Patients Paying More for Drugs
(Reuters Health)—A proposed shift in Medicare coverage for medicines administered by doctors may help reduce total drug spending, but a new study suggests it may also lead to higher out-of-pocket costs for some patients. Right now, drugs given by infusion or injection in outpatient settings are covered by Medicare Part B, which is part of…
AMA Opposes Merger of CVS & Aetna
WASHINGTON (Reuters)—the The American Medical Association, which represents U.S. physicians, urged the U.S. Justice Department on Wednesday to stop CVS Health Corp’s plan to buy insurance provider Aetna Inc, saying the deal could result in higher prices for prescription medicines. The AMA said that the $69 billion deal, announced in December, would lead to a…
ACR Praises Congress for Bill with Part B Fix, Therapy Caps Repeal
The ACR praises Congressional leaders for passing the sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauds the inclusion of provisions that permanently repeal Medicare…
Reminder: How to Handle Part D Prior Authorization Requests
As we begin another new year, many rheumatology practices will again receive prior authorization requests from Medicare Part D for all methotrexate prescriptions. When methotrexate is used as a chemotherapeutic drug, it’s covered by Part B, but when it’s used as an oral agent for rheumatoid arthritis, it’s covered by Part D. Early in the…