Medicare Part D

Medicare Part B could have saved $110 million, OIG asserts

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If the Medicare Part B program had used average Medicare Part D drug dispensing and fee rates, it would have saved the government $110 million in 2011, according to a report from the Department of Health and Human Services Office of Inspector General released Sept. 16.

CMS finalizes 1.4% increase for hospices

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Hospices can expect an estimated 1.4% increase in their payments for the fiscal year 2015, the Centers for Medicare & Medicaid Services announced Monday.

CMS announces Medicare appeals without administrative law judge hearings

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Long-term care providers will be able to appeal certain Medicare claims decisions without going through an administrative law judge hearing, the Office of Medicare Hearings and Appeals (OMHA) announced Thursday.

Medicaid paying 32% less than Medicare Part D for medications

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Medicaid is paying the lowest average price for 78 high-use and high-expenditure brand-name and generic drugs, a new federal report finds.

Charges that Omnicare forgave nursing providers' debts as a form of kickbacks can proceed, judge rules

Charges that Omnicare forgave nursing providers' debts as a form of kickbacks can proceed, judge rules

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A whistleblower can pursue charges that long-term care pharmacy Omnicare ignored skilled nursing companies' overdue bills in exchange for certain kinds of business, a federal district court recently ruled.

CMS wants tighter oversight for Medicare prescriptions

CMS wants tighter oversight for Medicare prescriptions

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The Centers for Medicare & Medicaid Services has seen enough and wants to gain more control over drug-prescribing practices for the Medicare Part D program.

Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

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In light of reports that Medicare Part D prescribing practices are endangering seniors — many of them in long-term care facilities — the Centers for Medicare & Medicaid Services has issued a proposed rule that would give the agency more power to oversee and control the prescription drug program.

CMS tightens procedures, oversight for hospice medication claims

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In light of widespread inappropriate claims, providers will face heightened scrutiny for Medicare claims for hospice medications, the Centers for Medicare & Medicaid Services stated in a letter this week.

Lost in Medicare Part D land

Lost in Medicare Part D land

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My mom called me to relay her "tragic" story of trying to sign up for a Medicare Part D plan. She hadn't signed up for one, and didn't feel that she needed one, but at lunch her girlfriends were discussing the pros and cons of their plans and asked Mom what plan she was on.

Bill calls for pharma to compensate for 'doc fix' solution; would readjust dual-eligibles payment

Bill calls for pharma to compensate for 'doc fix' solution; would readjust dual-eligibles payment

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Senator Jay Rockefeller wants provider groups to support his Medicare Part D plan for a drug rebate bill that calls for money from pharmaceutical companies to replace funds lost from the sustainable growth rate (SGR) removal.

Ask the care expert ... about unused medications

Ask the care expert ... about unused medications

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I am getting mixed information from experienced staff members as to what has been passed along by our pharmacy company about discharging patients with their controlled and scheduled medications. No one can give me a definite answer whether this is legal or not. Can you help?

Long-term care pharmacy groups propose changes to make short-cycle dispensing more efficient, cost-effective

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Long-term care pharmacies are struggling with an Affordable Care Act provision related to short-cycle dispensing of brand name oral solid drugs, according to a recent letter from the Long Term Care Pharmacy Alliance and the National Community Pharmacists Association.

Dual-eligibles are happy with Medicare Part D, survey finds

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About 90% of seniors, including dually eligible Medicare and Medicaid beneficiaries, are happy with Medicare's prescription drug program, a new survey reveals.

Donut hole dangers

Donut hole dangers

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It's well established that nursing home residents frequently struggle with conditions such as heart failure and depression. It's also true that critics of nursing home care are quick to blame these conditions on substandard care

Most meds used by dual eligibles are covered by Medicare Part D, OIG says

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The vast majority of the medications used by people who are dually eligible for Medicare and Medicaid can find what they need through Medicare Part D formularies, a federal report finds.

GOP senators float 'premium support' Medicare overhaul

GOP senators float 'premium support' Medicare overhaul

A new Medicare overhaul proposed by two Republican senators on Thursday would save an estimated $200 billion to $500 billion over 10 years by way of "premium support."

Medicaid drug costs are much lower than Medicare Part D costs, report finds

Medicaid's net unit drug costs are much lower than costs under Medicare Part D, which is attributed to higher Medicaid rebates for brand name medications, according to a new report.

Medicare Part D keeps seniors out of nursing homes, hospitals, study shows

Medicare Part D keeps seniors out of nursing homes, hospitals, study shows

Medicare's prescription-coverage program cuts healthcare costs by about $12 billion. That's because the benefit reduces admissions to nursing homes and hospitals, according to a new study.

Medicare Part D sponsors may be overcharging beneficiaries; investigation sought

Congressional Democrats are calling for a full review of the Medicare Part D program following a recent audit that found that many program sponsors have been overcharging beneficiaries by underestimating manufacturer rebates in their bids.

Some healthcare reform provisions take effect

Some healthcare reform provisions take effect

A number of key healthcare reform provisions affecting the long-term care industry began Jan. 1, right before the new session of Congress comes back to Washington, according to The Hill.

Open enrollment for Medicare Part D drug program sparks debate

In preparation for the Medicare Part D open enrollment period, the Centers for Medicare & Medicaid Services said it has streamlined its coverage options and eliminated choices it considered repetitive. But critics of the changes charge that eliminating such options undermines the spirit of President Obama's pledge, "If you like your plan you can keep it."

Beneficiary groups endorse plan to simplify Medicare Part D

A number of Medicare beneficiary advocacy groups have voiced support for a plan from the Department of Health and Human Services to simplify the Medicare Part D program. They want to reduce the number of available plans.

CMS confirms 50% discount for drugs in Medicare Part D coverage gap in 2011

The Centers for Medicare & Medicaid Services recently disclosed that 234 drug manufacturers that sell drugs covered by Medicare Part D have signed a pledge to provide a 50% discount to seniors who fall into the coverage gap, or doughnut hole.

Sebelius, Biden confirm Medicare Part D drug discounts next year amid skepticism of price hikes

Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius reassured seniors Thursday that there will be a 50% discount for those who fall into the Medicare Part D "doughnut hole" beginning next year.

Increased use of generic drugs helps to save Medicare Part D billions

The Medicare Part D prescription drug program saved more than $33 billion in 2007 due to the use of generic drugs, according to a new government report.

Medicare Part D premiums to rise modestly as drug discounts take effect

Medicare Part D premiums to rise modestly as drug discounts take effect

The average monthly Medicare Part D premium will rise by about $1 to $30 beginning next year. That is the same time that new benefits designed to begin closing the coverage gap kick in, health officials said Wednesday.

Democrats look to Medicare Part D checks to sway seniors by November

Democrats look to Medicare Part D checks to sway seniors by November

Many seniors are still wary of healthcare reform, but Democrats hope some of the new law's provisions will help win over reluctant elders, according to recent reports.

Improved Medicare Part D drug coverage leads to rise in antibiotic use, study finds

Improved Medicare Part D drug coverage leads to rise in antibiotic use, study finds

Antibiotic use by seniors has increased as a result of better drug coverage under the Medicare Part D drug program, according to a study by the University of Pittsburgh Graduate School of Public Health.

CMS releases drug maker agreement in move to close Medicare Part D coverage gap

CMS releases drug maker agreement in move to close Medicare Part D coverage gap

The Centers for Medicare & Medicaid Services on Monday took the next step in its bid to close the Medicare Part D coverage gap: It released a drug maker agreement that will secure 50% savings for beneficiaries next year.

Health agencies warn seniors about Medicare Part D rebate scams

Health agencies warn seniors about Medicare Part D rebate scams

As another round of $250 Medicare prescription drug rebate checks goes out in the mail, healthcare officials are reminding seniors to be aware of potential scams.

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