Articles related to MEDICARE

Because a growing number of Medicare-eligible patients — currently 48% of 58 million beneficiaries — are enrolled in Medicare Advantage plans, the problem of “no prior authorization” happens increasingly frequently these days. Some medical professionals believe that before their gullible patients switch their coverage, they should make a special effort to inform them of the drawbacks of these plans.

A video conversation between a senior advisor at ADVI, a physician from Texas Oncology, and the division director of practice health for ASCO discuss the main provisions of the Inflation Reduction Act (IRA) and its implications for oncologists and oncology practices. The panel discusses why practices may have to bear a larger share of the cost of drugs and be ready for utilization cuts by focusing on two important aspects of the IRA: the $2,000 cap on patients’ out-of-pocket expenses and Medicare price negotiation. All three concur that if the act isn’t changed, it might slow down the development of medicines for some indications.

In a three-page letter, Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan Contract Administration Group, stated that CMS is immediately stepping up its examination of marketing materials, which are required to be submitted in accordance with its legal “File and Use” authority for Medicare Advantage and Part D drug plans, and “may exercise its authority to prohibit” their use. As of right now, Medicare Advantage marketing materials are allowed to go live five days after being submitted, as long as the company submitting them “certifies the material complies with all applicable standards.” Starting January 1, 2023, however, no television advertisements will be eligible for submission under its “File and Use” authority, meaning that the advertisements will not air until CMS approves them.

All eligible Medicare beneficiaries who received treatment at Mayo facilities in Arizona and Florida over the previous three years were sent letters this past fall urging them to sign up for original Medicare and a supplement. When asked about the purpose of the letters, Kevin Punsky, the Mayo communications manager, said that they are meant to act as “a courtesy reminder” at the start of the annual Medicare re-enrollment window, which started on October 15.

A coming 8.5% cut in Medicare payments for surgery may be the proverbial straw in an already stressed system of surgical training, leading some to abandon their commitment to medicine.

Published in its entirety in the Journal of the American Geriatrics Society and available here from Guideline Central, the AGS Beers Criteria® also includes a host of resources— from mobile apps to a pocket reference card. The five lists included describe particular medications with evidence suggesting they should be avoided, used in caution, or dosed differently.