CMS Allows Absolute Biosimilar Substitution In Part D
Medicare Part D plans can now immediately substitute all FDA-approved biosimilars even if they are not deemed interchangeable by the drug approval agency, under the 2025 Medicare Advantage (MA) and Part D rule finalized by the Centers for Medicare and Medicaid Servies (CMS). Interchangeability is an extra step that drug makers take to substitute for brand biologics. The new rule will allow Part D plans to treat formulary substitutions of any biosimilars as maintenance changes as was allowed earlier just for interchangeables.
The Biden administration has pushed for biosimilar adoption in many ways and this is yet another. This should begin to mean lower biologic costs for Medicare members.
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#biosimilars #drugpricing #medicareadvantage #partd #medicare
CMS Changes MTM Criteria, Including Adding HIV/AIDs As Core Disease State
The Centers for Medicare and Medicaid Services (CMS) finalized changes for the 2025 Medication Therapy Management (MTM) program, including adding HIV/AIDs to the core disease states targeting criteria.
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#medicare #partd #mtm
Cuban’s Cost Plus Drugs Does Save
Notwithstanding the objections of traditional pharmacy benefits managers, this article shows how Mark Cuban’s Cost Plus Drug Company is saving on some high priced medications.
#cuban #transparency #pbms #drugpricing
Oscar Having Success In Exchanges
Good article on the success Oscar Health is having in the Exchanges, now roughly 1 million members. Some of this is driven by overall growth in the program, while some of it is due to Oscar’s innovation. Of the 24 start-up companies selling in the Exchanges, Oscar is the last one. Oscar sees great opportunities to expand, positive margins in the future, and potential with the Individual Coverage Health Reimbursement Arrangements (ICHRA).
#oscar #aca #exchanges #obamacare #ichra
Becker’s Summarizes MA And Part D 2025 Finalized Rule
Great summary of the major changes finalized by the Centers for Medicare and Medicaid Services in the 2025 Medicare Advantage and Part D rule.
#medicareadvantage #partd #medicare #cms
— Marc S. Ryan
