Articles related to HEALTHCARE COSTS

CMS has proposed 2027 ambulatory surgery center payment changes that would reduce reimbursement for several high-volume ophthalmic procedures, including cataract surgery. The proposal remains under review as ophthalmology organizations evaluate potential impacts on practice operations and patient access.

CMS proposed 2027 Physician Fee Schedule changes that would reduce reimbursement for certain same-day evaluation and management services performed with procedures. Ophthalmology organizations warned the changes could affect glaucoma treatment workflows, although the proposal remains under review.

Retina practices are adjusting after Good Days funding limitations reduced copay support for some patients requiring chronic anti-VEGF therapy. Medicare Advantage patients appear especially exposed to affordability pressure.

Across 14 health-system specialty pharmacies, pharmacist interventions were associated with an estimated $3.6 million in avoided medication costs over six months. The analysis used a structured attribution method to assess the likelihood that individual interventions altered treatment trajectories.

A cost-efficiency analysis found that ophthalmic ambulatory surgery centers may face growing financial pressure when performing procedures with high direct material costs under current Medicare reimbursement schedules.

ASHP urged HRSA in a June 2 letter to take immediate enforcement action against Eli Lilly after the manufacturer gave an initial group of 340B-covered entities five business days to submit detailed claims-level data or lose access to discounted pricing across its full drug portfolio, including in-house hospital pharmacy dispensing and medically administered products; as of mid-June, the threatened cutoffs had not yet taken effect for many affected entities.