Medicare & Medicaid
The suit alleges Humana committed to providing the required level of coverage, but in fact planned to provide less.
Cost to Medicare over a decade is likely to be in the low to middle tens of billions of dollars, Health Affairs says.
CMS said that if the new prices had been in effect last year, Medicare would have saved an estimated $6 billion across the 10 drugs.
Nationwide policy of 12-month continuous eligibility would allow these programs to operate more like private coverage and Medicare, letter says.
Actions won't impact Medicaid or ACA business in these states, where, notably, CVS and UnitedHealth Group both have presences, says Stephens report.
For 2025, CMS is increasing the long-term care hospital standard payment rate by 3%.
CMS did not finalize the ability for follow-up visits to be conducted by telehealth.
As expected, this year's ratings look much like 2023, given the methodology has remained stable, AHA says.
The government subsidy to Part D plans is shifting from being reconciled on the backend to a larger risk-adjusted payment upfront.
The hybrid payment structure may result in payment decreases that cannot be absorbed, the AHA said.