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Welcome to Global Integrated Reimbursement Services’ blog. The purpose of our blog is to allow access to a repository of issues that our company tracks regarding the reimbursement for pharmaceuticals, medical devices, diagnostics, biologics, and biosimilars. Also, it shows you how we can assist you in these areas.

CMS Releases Proposed Changes to Hospital Outpatient Prospective Payment System for 2018

Posted by on Jul 18, 2017 in Future Trends, Payment System | Comments Off on CMS Releases Proposed Changes to Hospital Outpatient Prospective Payment System for 2018

On July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) issued the CY 2018 proposed changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (CMS-1678-P). We discuss the proposed changes for the OPPS in this blog. These proposed changes would affect care delivery, drug costs, beneficiary out of pocket cost for several drugs and providers in rural areas. Additionally, CMS is also releasing a Request for Information to gain insight and ideas for regulatory, policy, practice, and procedural changes that would ” better achieve transparency, flexibility, program simplification, and innovation.” OPPS Proposed Changes Proposed OPPS Payment Update CMS proposes to update the OPPS rates by 1.75%for 2018. To understand the impact of this payment rate change, please contact us at info@girsinc.com. Payment with 340B Program Discount To address...

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CMS Delays the Inclusion of U.S. Territories Under MDRP Until 2020

Posted by on Dec 9, 2016 in Future Trends, Payer Coverage | Comments Off on CMS Delays the Inclusion of U.S. Territories Under MDRP Until 2020

The Center for Medicare and Medicaid Services (CMS) released an interim final rule (IFR), Medicaid Program; Covered Outpatient Drugs; Final Rule. The Rule delays the expansion of the Medicaid Drug Rebate Program (MDRP) to Puerto Rico and the U.S. Territories (collectively, “Territories”) for three years, until April 1, 2020. The inclusion of U.S. Territories under the MDRP has been delayed to account for the need for more time and the complexity of the transition for both the Territories and manufacturers. Unless granted a waiver, this expansion will require the U.S. Territories to participate in the MDRP, and also will require participating manufacturers to include sales to customers located in the Territories in their calculations of average manufacturer price (“AMP”) and Best Price. This expansion means that participating manufacturers will likely pay rebates to Territories and include sales to customers...

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Proposed Medicare Part B Cuts Draw Stakeholder Concern

Posted by on May 13, 2013 in Future Trends | Comments Off on Proposed Medicare Part B Cuts Draw Stakeholder Concern

The White House’s fiscal year (FY) 2014 budget proposal includes a variety of what it is calling “manageable” changes for Medicare’s 54 million beneficiaries as well as for hospitals, physicians, and other health care providers. One of these changes is a proposal to reduce cancer drug reimbursement from average sales price (ASP) plus 6 percent down to ASP plus 3 percent, a policy the White House estimates will save the federal government $3.3 billion over the next 10 years. Patient advocacy and provider groups as well as industry are calling foul. Ted Okon of the Community Oncology Alliance pointed out the proposal would exacerbate the 2 percent sequestration cuts already impacting cancer clinics with even steeper cuts to physician-administered drugs. Okon said he is “appalled” by the proposal though not surprised it appeared in the budget considering the “little sympathy” the Administration has...

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