Coverage and reimbursement decisions are hardly predictable or consistent within and across US payers. Payers are in the position of determining which drugs to pay for, for whom, and at what level to ...
Peter Salgo, MD: Here [it] comes, I’m afraid to say this, the $64-billion question: cheap drugs, new expensive drugs? What are the coverage criteria for these CGRPR [calcitonin gene-related peptide ...
On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization ...
In what passes for neon lights in the regulatory world, CMS said Medicare Advantage (MA) plans must follow the two-midnight rule, its case-by-case exception and the inpatient-only (IPO) list, ...
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