In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…
BluePeak AdvisorsDecember 17, 2019
The Organizational Determination (OD) and Coverage Determination (CD) process can be a source of frustration for members, prescribers and plans. The updates to Chapter 13 and 18 highlight the expectation…
BluePeak AdvisorsDecember 17, 2019
As year-end approaches, most plans are conducting claims testing to ensure that formularies and benefits are administered correctly on January 1 and beyond. Plans and PBMs alike that have experienced…
BluePeak AdvisorsDecember 17, 2019
Financial audits are just one of the many types of Medicare Part D audits. Financial audit frequency and awareness continues to increase, and plans are realizing that they must integrate…
BluePeak AdvisorsSeptember 9, 2019
Prior to 2019, plan sponsors were required to make an effort determine whether an immunosuppressant should be paid under Part D or Part B based upon information they had or…
BluePeak AdvisorsSeptember 9, 2019
The Centers for Medicare & Medicaid Services (CMS) released an HPMS memo on August 20, 2019 providing an overview of the upcoming changes to program audits through 2021. These changes…
BluePeak AdvisorsSeptember 9, 2019
From July 16-18th over 100 investigative minds met at the annual CMS Fraud Conference in Miami, Florida to talk about current fraud schemes, emerging schemes, data analytics and how to…
BluePeak AdvisorsAugust 2, 2019
On May 10, 2019, CMS published a final rule on Drug Pricing Transparency. The rule, effective July 9, 2019, requires direct-to-consumer television advertisements of prescription drugs and biological products payable…
BluePeak AdvisorsJune 11, 2019
During the CMS Spring Conference on May 1, 2019, CMS reviewed some of the revisions that are being made to Plan Finder. The redesigned Plan Finder will be used this…
BluePeak AdvisorsJune 11, 2019