Stephanie Lomas – 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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text]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…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] The Centers for Medicare & Medicaid Services (CMS) has released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA)…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program: Contract Year 2025 Policy and Technical Changes to the…

Discarded drug policy moves forward

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

The Debate over Step Therapy

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] 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…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Contract Year 2024 Policy and Technical Changes to the…

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

[vc_row full_width=”stretch_row” gap=”35″][vc_column][vc_column_text] The Centers for Medicare & Medicaid Services (CMS) has released its Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C…

Articles by Stephanie Lomas