Medicare Part D

Capital Rx's Enterprise Health Platform Enables Healthcare Organizations to Meet The CENTERS for MEDICARE & MEDICAID SERVICES' M3P Requirements

Retrieved on: 
Wednesday, March 27, 2024
M3P, Cost sharing, PBA, Partial differential equation, Entrepreneurship, Accounting, Pharmacy, Medicare Part D, Plasma protein binding, Hispanic and Latino Americans, Medicare, CMS, PBM, Health insurance

Capital Rx's M3P solution within JUDI® , the next-generation enterprise health platform, delivers a suite of capabilities covering billing and reporting, claims adjudication, cost sharing and tracking, program calculations, payment options, and the new pharmacy notifications necessary to meet CMS requirements for M3P, all in a single system.

Key Points: 
  • Capital Rx's M3P solution within JUDI® , the next-generation enterprise health platform, delivers a suite of capabilities covering billing and reporting, claims adjudication, cost sharing and tracking, program calculations, payment options, and the new pharmacy notifications necessary to meet CMS requirements for M3P, all in a single system.
  • "With JUDI, our clients can confidently meet all M3P with relative ease," said AJ Loiacono, Co-Founder and CEO of Capital Rx.
  • "When new programs are announced, our goal is to move quickly to establish the most efficient workflows and processes to meet regulatory requirements .
  • Please visit our website for more details about Capital Rx's M3P solution and answers to frequently asked questions.

CGI selected by Centers for Medicare & Medicaid Services to improve Medicare access for more than 65 million beneficiaries nationwide

Retrieved on: 
Tuesday, March 19, 2024
Automation, HPMS, CGI, Information technology, MAPD, CGI Inc., GIB, Medicare Part D, TSX, Medicare, Consultant, CMS, Medicare Advantage, Lead, Risk management

The contract includes a 1-year base period, as well as four 1-year option periods, for a total contract value of US$72M.

Key Points: 
  • The contract includes a 1-year base period, as well as four 1-year option periods, for a total contract value of US$72M.
  • CGI also will apply new and advanced technologies to help meet increasing stakeholder expectations and enhance cybersecurity to address new threat vectors.
  • With more than 70 software modules of varying sizes and complexity, HPMS supports critical functions impacting 65 million Medicare beneficiaries enrolling into MAPD health plans.
  • "CGI understands the current challenges in operationalizing data for the Medicare, Medicaid, and healthcare marketplace communities," said Steve Sousa, CGI Senior Vice-President & Health and Social Services Business Unit lead.

Local Pharmacies on the Brink, New Survey Reveals

Retrieved on: 
Tuesday, February 27, 2024
Pharmacy, DIR, CMS, Part, Thought, Sale, MBA, Letter, Pharmacist, Hardship, Human, Medicare, Patient, Tax, Express Scripts, Medicare Part D, CVS, NCPA, Congress, PBM, Caremark, Community, CBO, Prescription, Insurance, Pressure, Health insurance

The rule is intended to give pharmacies and patients more transparency on drug pricing.

Key Points: 
  • The rule is intended to give pharmacies and patients more transparency on drug pricing.
  • According to the new NCPA survey, 32 percent of all respondents say they are considering closing their doors in 2024 because of the cash crunch.
  • Increased vertical and horizontal consolidation of PBMs and health plans has caused severe inequities to pharmacies and Medicare Part D beneficiaries alike.
  • Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers.

UnitedHealth Group Update on Change Healthcare Cyberattack

Retrieved on: 
Friday, March 8, 2024
Security, Health, Technology, Practice Management, Health Insurance, Managed Care, Pharmacy, Medicine, Optum, Durable medical equipment, Electronic prescribing, Part, Change Healthcare, Manager, Medicare, Patient, Medicare Part D, UnitedHealth Group, Medicaid, Environment, Software, Health insurance

UnitedHealth Group continues to make substantial progress in mitigating the impact to consumers and care providers of the unprecedented cyberattack on the U.S. health system and the Change Healthcare claims and payment infrastructure.

Key Points: 
  • UnitedHealth Group continues to make substantial progress in mitigating the impact to consumers and care providers of the unprecedented cyberattack on the U.S. health system and the Change Healthcare claims and payment infrastructure.
  • “We are committed to providing relief for people affected by this malicious attack on the U.S. health system,” said Andrew Witty, CEO of UnitedHealth Group.
  • We’re determined to make this right as fast as possible.”
    Based on our ongoing investigation, there is no indication that any other UnitedHealth Group systems have been affected by this attack.
  • For more information and access to all solutions provided by UnitedHealth Group, visit http://www.uhg.com/changehealthcarecyberresponse .

Seres Therapeutics Reports Fourth Quarter and Full Year 2023 Financial Results and Provides Business Updates

Retrieved on: 
Tuesday, March 5, 2024
Biotechnology, Infectious Diseases, Health, Pharmaceutical, Clinical Trials, Fast Track, Therapy, HCP, Chronic liver disease, David Berry (inventor), Recurrence, Clostridioides difficile infection, Infection, Research, Fast track (FDA), Education, FDA, Term loan, Variometer, Growth, Use, Retirement, ID, Sale, CDI, Immunodeficiency, Oaktree Capital Management, Risk, Commercial, Graft-versus-host disease, Intensive care medicine, Medicare, Spore, Patient, Medicare Part D, Acceleration, Gastroenterology, Clostridioides, Limitation, AMR, Pharmaceutical industry

Seres Therapeutics, Inc. (Nasdaq: MCRB), a leading microbiome therapeutics company, today reported fourth quarter and full year 2023 financial results and provided business updates.

Key Points: 
  • Seres Therapeutics, Inc. (Nasdaq: MCRB), a leading microbiome therapeutics company, today reported fourth quarter and full year 2023 financial results and provided business updates.
  • From launch through year-end 2023, there were 2,833 completed prescription enrollment forms received for VOWST, of those 2,015 resulted in new patient starts by year-end 2023.
  • Strong adoption of VOWST since commercial launch in June 2023 with broad utilization, continued quarter over quarter growth, and significant progress achieving patient access.
  • General and administrative expenses for the fourth quarter of 2023 were $17.2 million, compared with $22.4 million for the same period in 2022.

Price Sensitive Medicare Advantage Enrollees Continue to Favor $0-Premium Plans and Lower Deductibles, eHealth Report Finds

Retrieved on: 
Thursday, March 7, 2024
AEP, Medicare, EHealth, Medicare Advantage, Medigap, Medicare Part D, Research, Insurance, Health insurance

AUSTIN, Texas, March 7, 2024 /PRNewswire/ -- For deeper insights into Medicare insurance trends, look beyond what's merely available in the market for beneficiaries to choose from. Look instead at what they actually select for themselves. eHealth's seventh-annual Medicare Index Report sets itself apart from other market analyses by doing just that.

Key Points: 
  • eHealth's seventh-annual Medicare Index Report sets itself apart from other market analyses by doing just that.
  • New original research published today by eHealth, Inc. (Nasdaq: EHTH) ( eHealth.com ), a leading online private health insurance marketplace, highlights average costs and plan selection trends among Medicare beneficiaries who chose Medicare Advantage and Part D plans through eHealth during the Annual Enrollment Period (AEP) for 2024 coverage.
  • Average premium for Medicare Supplement plans is up this year: Though enrollment in Medicare Supplement (Medigap) plans is not governed by AEP, the average premium for plans selected by eHealth customers during this period is up 9% year over year, from $173 to $189 per month.
  • Like other insurance brokers, eHealth is compensated on a fixed per-member basis for Medicare Advantage and Part D plans, as regulated by the Centers for Medicare and Medicaid Services, and on a percentage of premium basis for most Medicare Supplement plans.

Voices for Non-Opioid Choices Coalition Applauds Introduction of Alternatives to PAIN Act in Senate

Retrieved on: 
Thursday, February 29, 2024
PAIN, Opioid, Addiction, Pain, Drug, Risk, House, Pain management, Medicare, Patient, Medicare Part D, Representative, Alternatives, Senate, Health insurance

WASHINGTON, Feb. 29, 2024 /PRNewswire/ -- Today, the Senate took a crucial step forward in the fight to prevent opioid addiction by introducing the bipartisan Alternatives to Prevent Addiction in the Nation (PAIN) Act. The Alternatives to PAIN Act will ensure that all Americans can access safe, effective, non-addictive pain management approaches. In the process, the Alternatives to PAIN Act can prevent opioid addiction that occurs following an acute pain incident and save lives.

Key Points: 
  • The Alternatives to PAIN Act will ensure that all Americans can access safe, effective, non-addictive pain management approaches.
  • In the process, the Alternatives to PAIN Act can prevent opioid addiction that occurs following an acute pain incident and save lives.
  • "Over one million American seniors are diagnosed with opioid addiction every year," said Chris Fox, Executive Director of the Voices for Non-Opioid Choices Coalition .
  • In January, Representative Mariannette Miller-Meeks (R-IA) and Representative Tony Cárdenas (D-CA) introduced companion legislation, The Alternatives to PAIN Act (H.R.

AM Best Comments on Health Care Service Corporation’s Planned Acquisition of The Cigna Group’s Medicare Business

Retrieved on: 
Friday, February 2, 2024
Insurance, Professional Services, Cigna, Medigap, Medicare Part D, News, AM Best, HCSC, Credit, Health Care Service Corporation, Acquisition, ALL, Medicare

The transaction is expected to expand HCSC’s geographic diversification with the addition of business outside of HCSC’s core Blue Branded states.

Key Points: 
  • The transaction is expected to expand HCSC’s geographic diversification with the addition of business outside of HCSC’s core Blue Branded states.
  • Additionally, the additional membership and revenues will aid in providing additional scale and capabilities to HCSC’s Medicare Advantage business.
  • The transaction is expected to close in the first quarter of 2025, subject to regulatory approval and customary closing conditions.
  • AM Best is a global credit rating agency, news publisher and data analytics provider specializing in the insurance industry.

AM Best Places Credit Ratings for Several Subsidiaries of The Cigna Group Under Review with Developing Implications

Retrieved on: 
Friday, February 2, 2024
Banking, Professional Services, Insurance, Finance, Medigap, Medicare Part D, News, AM Best, FSR, Credit, Health Care Service Corporation, Medicare Advantage, ALL, Medicare

Concurrently, AM Best also has placed under review with developing implications the FSRs of A (Excellent) and the Long-Term ICRs of “a” (Excellent) of four Cigna HealthSpring companies.

Key Points: 
  • Concurrently, AM Best also has placed under review with developing implications the FSRs of A (Excellent) and the Long-Term ICRs of “a” (Excellent) of four Cigna HealthSpring companies.
  • All entities are part of The Cigna Group (collectively referred to as Cigna) (headquartered in Bloomfield, CT) [NYSE: CI].
  • The Credit Ratings (ratings) of all other Cigna entities are unaffected.
  • For additional information regarding the use and limitations of Credit Rating opinions, please view Guide to Best's Credit Ratings .

ECHO’s Simplicity Platform Expands to Support Medicare Prescription Payment Plan with its SimplicityRx Solution

Retrieved on: 
Wednesday, January 31, 2024
Technology, Payments, Health Technology, Health Insurance, Software, Health, Pharmaceutical, General Health, Data Management, CMS, Simplicity, ECHO, Pharmacy, Medicare, Medicare Part D, Health insurance

ECHO Health, Inc. (ECHO®), a payments company focused on removing complexity and costs from payment processing, today announced that is expanding an existing solution to launch SimplicityRx.

Key Points: 
  • ECHO Health, Inc. (ECHO®), a payments company focused on removing complexity and costs from payment processing, today announced that is expanding an existing solution to launch SimplicityRx.
  • This solution empowers Medicare Part D sponsors to meet the Centers for Medicare and Medicaid Services (CMS) new program requirements for Medicare Prescription Payment Plan (M3P), which allows participants to spread prescription drug costs into monthly payments.
  • Built on ECHO’s Simplicity platform already in the market today, the technology supporting SimplicityRx is tested, reliable, and ready to implement.
  • The Simplicity platform is powered by ECHO’s technology currently integrated with over 350 health plans and Third-party Administrators (TPAs).