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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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Rebate Rule: Is it Finally Happening?

Krista Maier, JD January 30, 2021 Healthcare Policy

Quick Summary: In November 2020, the Trump Administration released the final rule …

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Rutledge vs PCMA: An Overview of the Supreme Court PBM Case

Krista Maier, JD November 25, 2020 Healthcare Policy

Quick Summary: A 2015 Arkansas law requires pharmacy benefit managers (PBMs) to …

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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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Managed Care Payer Implications Associated with Asset Transfer

Kevin Donlan, R.Ph., M.S. October 26, 2020 Market Access, Strategy

Within the pharmaceutical industry, it is common for a manufacturer to sell …

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A Closer Look at Executive Order 13939: Lowering Prices for Patients by Eliminating Kickbacks to Middlemen

Krista Maier, JD October 1, 2020 Healthcare Policy

Quick Summary: Requires HHS to finalize the proposed rebate rule that was …

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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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Review of the President’s Executive Order on Access to Affordable Life-saving Medications (EO 13937)

Krista Maier, JD September 8, 2020 Healthcare Policy

Quick Summary: Requires Federally Qualified Health Centers to provide 340B prices for …

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