CMS won't impose Medicare Part D pharmacy access standards | HHS proposes cutting Medicare Advantage rates by 0.9% | Administration releases rule on enrollment dates for 2016 ACA plans
February 23, 2015
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Featured Story
CMS won't impose Medicare Part D pharmacy access standards
The CMS opted against putting forth new mandates on popular, lower-cost Part D plans that feature preferred pharmacies, signaling the agency will likely table the adequacy standards issue going forward. (subscription required) (2/20)
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From an educational standpoint, speakers at the sPCMA Business Forum are among the industry's top thought leaders. When it comes to networking and conducting business with industry partners and customers, the Business Forum attracts the highest number of PBM and specialty pharmacy senior executives and decision makers of any industry conference. Learn more.
Legislative & Regulatory News
HHS proposes cutting Medicare Advantage rates by 0.9%
Payments from the federal government to Medicare Advantage plan carriers would be reduced by 0.9% in 2016 under an HHS proposal. HHS also plans full implementation of a new way of paying insurers that have sicker-than-average customers, which could further reduce payments. Reuters (2/20), Bloomberg (2/20)
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Administration releases rule on enrollment dates for 2016 ACA plans
The open enrollment period for a 2016 Affordable Care Act health insurance plan will run from Nov. 1 through Jan. 31 under a final rule issued by the Obama administration. The Wall Street Journal (tiered subscription model)/Washington Wire blog (2/20)
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Some taxpayers will get special ACA open enrollment period
Uninsured tax filers in states using the federal exchange will get another chance to enroll, from March 15 to April 30, the Obama administration announced. The IRS is also sending new forms to about 800,000 tax filers to correct subsidy errors. Reuters (2/20), The Washington Post (tiered subscription model)/Wonkblog (2/20)
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Former Mich. pharmacy CEO pleads guilty to role in health care fraud scheme
Kim Duron Mulder, the former CEO of Kentwood Pharmacy in Grand Rapids, Mich., pleaded guilty on Friday to conspiracy to commit health care fraud. Mulder said he permitted a drug-repackaging scheme to continue and allowed his workers to restock and redispense unused drugs returned by nursing homes and care centers. Mulder is scheduled for sentencing on July 9 and faces up to 10 years in prison. (Michigan) (free registration) (2/20)
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Tax mistake affects 800K users
About 800,000 people enrolled in a health insurance plan through the federally run exchange received incorrect information regarding subsidies and have been asked to postpone filing their tax returns until they receive correct information. The Washington Post (tiered subscription model)/Wonkblog (2/20), The New York Times (tiered subscription model) (2/21)
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Other News
Drug Industry Spotlight
Court affirms ruling that blocks Teva's generic HIV drug, permits Lupin generic
The U.S. Court of Appeals for the Federal Circuit affirmed a lower-court decision that permits Lupin Pharmaceuticals to market its generic version of ViiV Healthcare's HIV drug Trizivir but prohibits Teva Pharmaceutical Industries from selling its generic version of Epzicom, another HIV drug from ViiV, until the drug goes off patent in March 2016. The ruling stemmed from patent infringement lawsuits filed by ViiV against the two drugmakers that were later consolidated into one case. FDAnews (2/23)
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Other News
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PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 216 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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