PBM Archives - BluePeak Advisors

PBM September 2023

2024 National Average Monthly Bid Amount Impact

On July 31, 2023, Centers for Medicare & Medicaid Services (CMS) released the National Average Monthly Bid Amount (NAMBA) for contract year (CY) 2024. For 2024, the national average bid…

BluePeak AdvisorsSeptember 7, 2023

CMS Compliance PBM PDE

The PDE Submission Deadline is Rapidly Approaching-Don’t Assume a High Acceptance Rate Translates to PDE Accuracy

The 2021 PDE submission deadline is June 29, 2022. Plans must attest to the accuracy of their submitted PDE records prior to CMS’ financial reconciliation. The challenge is that many…

BluePeak AdvisorsFebruary 12, 2022

CMS PBM

‘Tis ALWAYS the season….for rejected claims analysis.

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

Legal PBM

Question & Answer

Q: Is it permissible for the Compliance Officer to report to General Counsel or the Legal Department? A: While some Plans and PBMs do this, it is not ideal or…

BluePeak AdvisorsJune 11, 2019

Compliance IRE MA MA-PD Part D PBM

Using Interim Staffing to bring Appeals and Grievances Timeliness into Compliance–A Case Study

Sometimes, life happens. Turnover, volume increases, changing guidance, system changes or audit issues that require remediation all can create situations where a Plan or PBM needs expert resources fast. And…

BluePeak AdvisorsMarch 15, 2019

CMS Medicare Part C Part D PBM

Proposed Rule Aimed at Drug Price Transparency Could Lead to Inadvertent Member Confusion

On October 18, 2018, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule which, if finalized, will amend the Medicaid and Medicare Parts A, B, C, and…

BluePeak AdvisorsNovember 22, 2018

CMS MAT Medicare MME Opioids Part D PBM

CMS Continues to Deploy Revised Strategies to Assist with Identifying and Deterring Opioid Abuse

To assist Medicare Part D sponsors with monitoring efforts and potentially avoid overutilization of opioids in the elderly Medicare population, CMS has deployed numerous strategies over the past several years…

BluePeak AdvisorsSeptember 21, 2018

Audits CDAG CTM FAA PBM TPMA

New Year’s Day is Ultimate Test of New Part D Plan Year Readiness

While most people are singing Auld Lang Sine at midnight on January 1, those of us in the Medicare world are anxiously awaiting the first claims of the plan year…

BluePeak AdvisorsNovember 27, 2017

CDAG CMS CPE FDRs PBM

Opioid Epidemic Spotlights Health Plans’ FWA Investigations

On October 26, President Donald Trump declared the nation’s opioid epidemic a public health emergency. The opioid epidemic is the deadliest drug epidemic in American history. Deaths from opioid overdose…

Michelle Rigby, CFENovember 3, 2017

ANOC/EOC CMS Compliance CPE CTM HPMS PBM Uncategorized

2018 is Around the Corner – Are You Ready?

Bid approved – check. Member materials sent to printer – check. What other items should be on your radar over the next few months? The Centers for Medicare and Medicaid…

Kim Mullins, MBASeptember 15, 2017