February 15, 2023
Payers | Tea Leaves
  • The Biden administration rolled out three new payment models intended to lower drug costs, including new Medicare coverage options for drugs cleared under accelerated approval. The Center for Medicare and Medicaid Innovation (CMMI) did not give a timeline for when the models will start soliciting applications or launch, but CMMI director Liz Fowler indicated that the model for generic drugs won’t be in place for the 2023 Medicare open enrollment or the 2024 period as well. The center is also firming up which models will be voluntary and mandatory. Fowler said that it is likely the gene and cell therapy model as well as generic drug model will be voluntary, with the verdict still out for accelerated approval. (Articles here and here)
  • The Centers for Medicare and Medicaid Services (CMS) have instructed arbitrators for out-of-network payment disputes to pause and recall certain payment determinations due to a recent court decision striking down key parts of the agency’s surprise billing regulations. CMS said ina Friday notice that its departments “are in the process of evaluating and updating” implementation of the Federal Independent Dispute Resolution process to be consistent with a February 6 ruling from the U.S. District Court for the Eastern District of Texas. The court agreed with the provider plaintiff, the Texas Medical Association, that CMS once again went against the congressional intent of 2020’s No Surprises Act. (Articles here, here, and here)