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Prepare for Part D audits
The impact and magnitude of expenditures should have made Part D an immediate enforcement priority for the Centers for Medicare and Medicaid Services
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established the Medicare Part D outpatient prescription drug benefit, which took effect on January 1, 2006. The impact and magnitude of expenditures should have made this an immediate enforcement priority for the Centers for Medicare and Medicaid Services (CMS) to ensure that the Part D program operates efficiently and is protected from fraud and abuse.
While CMS is responsible for oversight and implementation of safeguards to protect the integrity of the Part D benefit, oversight of Part D programs continued to evolve slowly-until now. An effective compliance plan helps sponsors protect the integrity of Medicare funds by preventing fraud, waste and abuse.
Since 2005, federal regulations have required sponsors to have compliance programs in place. Chapter 9 of CMS's Prescription Drug Benefit Manual ("Part D Program to Control Fraud, Waste and Abuse," available online), provides guidance on the elements outlined in regulatory requirements along with additional requirements and recommendations. It will be updated by CMS soon, making requirements more stringent.
A Conversation With Greg Baker, RPh, CEO of AffirmedRx
March 31st 2024Greg Baker, CEO of AffirmedRx, describes his early career, shares some of his critical opinions about the pharmacy benefit management (PBM) industry and how, in his view, his company is offering a better alternative.
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Extending the Capabilities of the EHR Through Automation
August 2nd 2023Welcome back to another episode of "Tuning In to the C-Suite," where Briana Contreras, an editor of Managed Healthcare Executive, had the pleasure of chatting with Cindy Gaines, chief clinical transformation officer at Lumeon.
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Florida Gets the OK. But Will Drug Importation from Canada Actually Happen?
March 5th 2024Canadian health officials warn that maintaining a drug supply for Canadians is their priority. The staunch opposition of the U.S. pharmaceutical industry may also be an obstacle to imports from north of the border.
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The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
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