Medicare Prescription Payment Plan (M3P) Educational Overview

October 8, 2024

Medicare

With Open Enrollment right around the corner, Medicare eligible members can begin opting in to the Medicare Prescription Payment Plan (M3P). Discover more about the M3P program and how Express Scripts by Evernorth supports clients with a solution.

Watch now: https://bit.ly/47yF5vf

legislation

CMS Releases Final 2026 MA Policy and Technical Rule; Declines to Finalize Coverage of GLP-1s

On April 4, the Centers for Medicare & Medicaid Services (CMS) finalized the 2026 MA Policy and Technical Changes rule. Of note, CMS is not finalizing certain provisions from the proposed rule, most importantly the proposal requiring coverage of anti-obesity medications (AOMs) in both Medicare and Medicaid. CMS said that it may address these proposals […]
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April 9, 2025

EGWP marketplace medicaid Medicare

legislation

Budget Reconciliation Process Continues with Senate Consideration of Revised House Resolution

On April 5, the Senate voted 51-48 to pass a modified version of the House-passed budget resolution with reduced deficit reduction targets for Senate committees as compared to the House. Specific to health care, the revised Senate resolution instructs the Senate Finance Committee (SFC), which has jurisdiction over Medicaid, to propose changes that will increase […]
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April 9, 2025

medicaid

legislation

2026 Final Rate Announcement for MA and Final Part D Program Instructions

On April 7, CMS released the Calendar Year (CY) 2026 MA and Part D Final Rate Announcement and the Final CY 2026 Medicare Part D Program Instructions. The Administration strongly defended its focus on fraud, waste, and abuse, while protecting beneficiaries. The final rate notice increases average payments to MA plans by 5.06% up from […]
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April 9, 2025

EGWP medicaid Medicare

AAF Analyzes Financial Burden of a Single-Payer System

American Action Forum (AAF) recently published insights into the potential costs of changing the U.S. health care system to a single-payer system, sometimes referred to as “Medicare for All” (M4A). Over the past decade, numerous Democrats have proposed that patients would be “better off” with a single-payer system, where the federal government is the sole […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

McLaughlin Poll Finds Voters Oppose Government Intervention in the Private Market

PCMA released results from a public opinion research conducted by McLaughlin & Associates showing that American voters in battleground states overwhelmingly oppose policies that interfere with the private market and believe drug companies should be held accountable for high drug prices. The survey found that 94% of battleground state voters are concerned with the high […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

New Research Finds Direct-to-Consumer (DTC) Pharmaceutical Advertising Costs U.S. Taxpayers Billions of Dollars

As reported in Politico, a new analysis by CSRxP finds that limiting or taxing DTC ads could increase federal revenue by up to $1.8 billion annually. The analysis is based on the potential tax impact if advertising expenses were not tax-deductible as they are today. The research found that 10 of the largest pharmaceutical manufacturers […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

AHIP Releases Nationwide Poll Showing Strong Satisfaction with Employer-Provided Coverage

AHIP’s Coverage@Work released the results of a new nationwide poll that found strong satisfaction with employer-provided coverage. A growing majority of consumers (75%, up 12% since April 2023) are satisfied with their current employer-provided coverage and 74% prefer to get their coverage through their employer. Plan satisfaction is driven by the comprehensive coverage (49%), affordability […]
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December 10, 2024

marketplace

survey results

Lown Institute Study Finds Unnecessary Back Surgeries Cost Medicare $600 Million Annually

A new analysis from the Lown Institute, an independent think tank, found that hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries in the U.S. over three years. Roughly $2 billion was spent on the “low value” procedures while patients were put at risk of poor outcomes, researchers wrote. The researchers looked at […]
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December 10, 2024

EGWP Medicare