Master the upcoming ICD-10 code and IPPS changes! Prepare your team for the upcoming changes taking effect on October 1. Discover the benefits of IPPSPalooza and how it can drive your success. Click here >
The price applicability is set to kick in for 2026.
Calling it a “historic” announcement, federal officials this week introduced guidance for the Medicare Drug Price Negotiation Program, which will give the federal agency the ability to negotiate lower prescription drug prices.
The move was made possible due to President Biden’s Inflation Reduction Act, intended to rein in healthcare and prescription drug costs. The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) made the announcement in a joint press release, noting that they are now soliciting requests for public comment for the 2026 calendar year, the first year the negotiated prices will apply.
“For far too long, millions of Americans have had to choose between their prescription drugs and other monthly expenses,” HHS Secretary Xavier Becerra said in a statement. “President Biden is leading the fight to lower the cost of prescription drugs – and with the Inflation Reduction Act, we’re making historic progress. Through the Medicare Drug Price Negotiation Program, we will make sure seniors get a fair price on Medicare’s costliest prescription drugs, promote competition in the market, and ensure Medicare is strong for beneficiaries today and into the future.”
“Drug price negotiation is a critical piece of how this historic law improves the Medicare program,” CMS Administrator Chiquita Brooks-LaSure added. “By considering factors such as clinical benefit and unmet medical need, drug price negotiation intends to increase access to innovative treatments for people with Medicare.”
Officials noted that Medicare’s negotiation process will focus on key questions, including but not limited to the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on Medicare enrollees. As a result of negotiation, people with Medicare will have access to “innovative, life-saving treatments at costs that will be lower for both them and Medicare,” the press release read.
“Negotiation is a powerful tool that will drive drug companies to innovate to stay competitive, fostering the development of new therapies and delivery methods for the treatments people need,” said Meena Seshamani, MD, PhD, CMS Deputy Administrator and Director of the Center for Medicare. “This initial guidance is the next step in the extensive engagement CMS has had to date with interested parties, and we look forward to continuing to receive comment on key policy areas and engage with the public as we implement the Negotiation Program.”
Key dates for implementation include the following:
Comments received by CMS by April 14 will be considered for revised guidance, which will be released for the first year of negotiation this summer.
“CMS is committed to collaborating and engaging with the public in the implementation of the Inflation Reduction Act … (and is) working closely with patients and consumers, Medicare Part D plan sponsors and Medicare Advantage organizations, drug companies, hospitals and healthcare providers, wholesalers, pharmacies, and others,” the press release concluded. “Public feedback contributes to the success of the Medicare Drug Price Negotiation Program, and this initial guidance is one tool, among many, that CMS will use to ensure interested parties know when and how they can make their voices heard on implementation of this new drug law.”
To view a fact sheet on the Medicare Drug Price Negotiation Program Initial Guidance, go online to: https://www.cms.gov/files/document/fact-sheet-medicare-drug-price-negotiation-program-initial-guidance.pdf
To read the Medicare Drug Price Negotiation Program Initial Guidance, go to: https://www.cms.gov/files/document/medicare-drug-price-negotiation-program-initial-guidance.pdf
EDITOR’S NOTE: The following op-ed is exclusively comprised of the opinions of the individual author, which are not necessarily shared by RACmonitor or Monitor Mondays.
Just as the role of physician advisors has come to the forefront of the healthcare world over the last decade and a half, so too
Please log in to your account to comment on this article.
The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.
A massive task lies ahead! Now’s the time to start preparing your case management and utilization review teams for successful implementation of changes contained in the 2024 IPPS, OPPS and MPFS rules.
Gain clarity on billing, patient notifications, and discharge appeal rights in social admissions. Join our webcast for essential insights and strategies to navigate this complex landscape, ensuring financial stability and optimal patient care.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.
Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.
This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts
Copyright © 2023 ICD10monitor. Powered by MedLearn Media.
