Stephanie Lomas, Author at Applied Policy

CMS Releases Final Rule for 2026 for Health Insurance Marketplaces, Aimed at Safeguarding Consumers, and Improving Transparency and Health Equity

On January 13, 2025, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit…

CMS Finalizes CY 2025 Policy Changes for Medicare Advantage and Part D Plans Impacting Patient Protections, Utilization Management, and Formularies

On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program…

CMS Releases Final Rule for 2025 Qualified Health Plans, Aimed at Strengthening Network Adequacy, Patient Access and Protections and Improving Plan Selection and Enrollment

On April 2, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit…

For 2025, CMS Finalizes Changes Resulting in a 3.7% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit Redesign

On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C…

For 2025, CMS Proposes Changes Resulting in a 3.7% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit Redesign

The Centers for Medicare & Medicaid Services (CMS) has released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and…

CMS Proposes CY 2025 Policy Changes for Medicare Advantage and Part D Plans Impacting Patient Protections, Utilization Management, and Formularies

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program: Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program,…

Discarded drug policy moves forward

As Applied Policy reported in January, under Section 90004 of Infrastructure Investment and Jobs Act (Infrastructure Act) which was passed in November 2021, manufacturers of drugs, including biosimilar biologic products,…

The Debate over Step Therapy

Step therapy is the process under which a health insurance plan requires a patient to try one or more alternative—typically lower cost— drugs or treatment options before they…

CMS Releases Final Rule for 2024 Qualified Health Plans, Strengthening Network Adequacy Standards, and Expanding Consumer Access

On April 17, 2023, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit…

CMS Finalizes CY 2024 Policy Changes for Medicare Advantage and Part D Plans Impacting Plan Utilization Management, Patient Protections, and Health Equity

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program,…

For 2024, CMS Finalizes Changes Resulting in a 3% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit

The Centers for Medicare & Medicaid Services (CMS) has released its Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D…

For 2024, CMS Proposes Changes Resulting in a 1% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit

The Centers for Medicare & Medicaid Services (CMS) has released its Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and…

Articles by Stephanie Lomas