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CMS Proposes Revised Definition of Medicare Part D Drug “Negotiated Prices”: Rule Could Increase Predictability for Pharmacies and Lower Medicare Enrollee Drug Cost-Sharing but Increase Premiums

On January 6, 2022, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule entitled “Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs” (the “2022 Proposed Rule”). Of great significance to Medicare Part D plan sponsors, pharmacies, and beneficiaries, the 2022 Proposed Rule includes proposed changes to the way Medicare determines the “negotiated price” (i.e., the price upon which beneficiary cost-sharing is based at the pharmacy counter), and consequently could affect Part D plan sponsors’ reporting of costs to CMS. If finalized in its current form, the 2022 Proposed Rule could enhance predictability of cash flow for pharmacies, reduce out-of-pocket prescription drug costs for Medicare Part D enrollees, and lead Part D plan sponsors to raise premiums, thereby causing increased competition among Part D plan sponsors for beneficiaries. The 2022 Proposed Rule would take effect on January 1, 2023. Comments on the rule are due by March 7, 2022.

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State and Local Jurisdictions Impose Restrictions on Gatherings and Non-Essential Businesses: Defining What is, and is not, an “Essential Business” that Can Remain Open in Non-Remote Mode


Time to Read: 1 minutes Practices: Health Care

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Several jurisdictions recently imposed restrictions to limit the size of gatherings and close or reduce in-person operations of various “non-essential businesses,” all in order to slow the spread of COVID-19 through increased social distancing. Below, we summarize the restrictions and the exceptions for “essential businesses” applicable to dozens of jurisdictions. Because these public health recommendations (and in some cases, mandatory orders) are issued from the state and local/county/municipal levels of government, they are not uniform across the U.S., and their definitions of “essential businesses” may differ from state to state and from city to city. Close attention to the specific terms of these local and state department of health issuances is therefore critical. We offer this compendium in order both to give some current information about these local orders, as well as to demonstrate how these orders may differ geographically. 

View the PDF to read all recent orders.

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