The Biggest Takeaways from CMS’s Annual Spring Conference

June 28, 2019

This spring, the Centers for Medicare and Medicaid Services (CMS) held an event that you and your health plan will want to know about. Each year, CMS’s annual Medicare Advantage & Prescription Drug Plan Conference provides important information to health plan provider staff, management, and executives regarding updates to existing Medicare policies, technology, and much … Read more

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Should my health plan outsource or handle CMS compliance in-house?

May 27, 2019

Why You Should Outsource Your Health Plan Headaches Benjamin Franklin once said nothing in this world is certain except death and taxes. In twenty-first century America, this quote could be updated with a refrain: Nothing is certain except death, taxes, and the labyrinthine nature of our healthcare system. Right now, the United States is in … Read more

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What can Tier 1 Do for Your Health Plan?

May 14, 2019

Take a second look at what we do. Tier 1 Pharmacy Consulting prides itself on adding value to their clients’ businesses not only through the services it offers, but also by engaging in frequent knowledge-sharing via its online blog. Regulations, standards, and methods of operation in the overlapping worlds of health care, health plans, and … Read more

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HHS proposes removing safe harbor for drug rebates

April 16, 2019

Prescription drug prices have risen every year for nearly a decade at rates that are higher than the U.S. inflation rate. The costs of brand name oral drugs nearly doubled between 2008 and 2016, according to an ABC news report earlier this year. The increase was five times that of the inflation rate. Generic oral … Read more

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CMS proposes updates to audit Civil Monetary Penalties

March 29, 2019

Medicare plans and pharmacy teams are being heavily scrutinized by the Centers for Medicare and Medicaid Services – now more than ever before. The changes CMS has implemented for 2019 as well as upcoming proposed changes for the next few years suggest that plans are more likely to be audited than not. An audit is … Read more

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CMS Draft Call Letter Released; Opioid Use Worrisome

March 25, 2019

Opioids remain a concern for officials at the Centers for Medicare and Medicaid Services (CMS). The agency has announced that addressing the epidemic – addiction, misuse, overdose and death – is one of its top priorities, and that officials have made big changes to 2019 Medicare Part D Opioid Prescribing Policies as a result. More … Read more

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CMS FAQ’s to Audit Program: What You Should Know

March 11, 2019

The Centers for Medicare and Medicaid Services receives hundreds, if not thousands, of emails from health plans with questions about changes and updates to the agency’s audit program. In many cases, CMS says, the same answers are sought. Because of that, the agency has published an outline of the questions organizations tend to ask most … Read more

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CMS proposals to Medicare Part D address skyrocketing prescription drug costs

January 31, 2019

Prescription drug costs are a huge concern for Americans of all ages, especially those age 50 and older. A 2016 AARP survey of nearly 2,000 people found that 81 percent of older patients believe drug prices are too high. Nine out of 10 want the government to address the problem. At the same time, a … Read more

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Opioid epidemic a CMS priority in 2019

January 29, 2019

At least 130 people a day die of an opioid overdose in the U.S., according to the Centers for Disease Control and Prevention. In 2017, fatal opioid overdoses were six times higher than they were in 1999. More than 191 million opioid prescriptions – including Oxycodone, Hydrocodone and Methadone – were dispensed to patients across the … Read more

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CMS Changes to 2019 Audit Protocol: What You Need to Know

January 21, 2019

Pharmacy teams can now expect their drug management programs to fall under considerable audit scrutiny by the Centers for Medicare and Medicaid Services regarding a new federal law that aims to prevent prescription opioid misuse and addiction. For the first time, CMS will look at health plans’ implementation of the Comprehensive Addiction and Recovery Act throughout … Read more

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