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Home Posts by “Ethan Heidorn”

TennCare III: A Potential Case Study in the Impact of CMS’ Approved Tennessee Aggregate Cap Demonstration Waiver in Medicaid

Ethan Heidorn May 28, 2021 Healthcare Industry, Healthcare Policy

Quick Summary: Allows Tennessee Medicaid to cover the greater of either one …

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Dual Specialty Tiers in Medicare Advantage and Part D Plans: What Does it Mean?

Ethan Heidorn May 14, 2021 Market Access

Quick Summary: Allows Medicare Advantage and Part D plans to offer a …

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UPDATE: CMS Finalizes Proposed Changes to the Medicaid Drug Rebate Program: What Might That Mean for Value-Based Contracts?

Ethan Heidorn April 30, 2021 Healthcare Policy

Quick Summary: Finalizes new definition of Value-Based Purchasing (VBP) arrangements Took effect …

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CMS Final Rule on the Definition of Line Extension, New Formulation, and Oral Solid Dosage Form for Alternative URA Calculation

Ethan Heidorn March 13, 2021 Healthcare Policy

Quick Summary: Finalizes a regulatory definition of a “line extension,” “new formulation” …

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CMS Final Rule on Impact of Certain Manufacturer Sponsored Patient Assistance Programs on “Best Price” and Average Manufacturer Price (AMP)

Ethan Heidorn March 1, 2021 Healthcare Policy

Quick Summary: CMS has decided to no longer exclude certain manufacturer-sponsored copay …

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HHS Finalizes Payer Transparency Rules

Ethan Heidorn February 15, 2021 Healthcare Policy

Quick Summary: Beginning in 2022, insurers must post online machine-readable files that …

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CMS Finalizes Rule Permitting Copay Accumulator Adjustment Programs in 2021: What Does It Mean?

Ethan Heidorn November 12, 2020 Healthcare Policy

Quick Summary: CMS finalizes rule allowing plan sponsors to utilize a Copay …

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Proposed Changes to the Medicaid Drug Rebate Program: What Might That Mean for Value-Based Contracts?

Ethan Heidorn September 17, 2020 Healthcare Industry

Quick Summary: CMS proposes two potential rules for adjusting “best price” determinations …

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CMS Launches Model to Lower Out-of-Pocket Expenses for Insulin

Ethan Heidorn September 16, 2020 Healthcare Industry

Quick Summary: Lowers Medicare beneficiaries’ out-of-pocket costs for a broad set of …

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