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 the CY2026 Advance Rate Notice and Draft Part D Program Instructions

On Jan. 10, CMS released the Calendar Year (CY) 2026 Medicare Advantage and Part D Advance Notice which includes methodological and payment policy changes for the programs in 2026. The Advance Notice also includes draft program instructions for CY 2026 for the Medicare Part D program under the redesigned Part D benefit as required by […]
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February 11, 2025

EGWP Medicare

legislation

HHS Releases 2026 Notice of Benefit and Payment Parameters Final Rule

On Jan. 13, HHS issued the final Notice of Benefit and Payment Parameters for 2026 (NBPP). HHS states the rule finalizes safeguards to protect consumers from unauthorized changes to their coverage, measures to ensure the integrity of federally run marketplaces, and provisions to make it easier for consumers to understand costs and enroll in coverage. […]
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February 11, 2025

EGWP marketplace medicaid Medicare

legislation

HHS Proposes Changes to HIPAA Security Rule

On Dec. 27, HHS issued a proposed rule to modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule to require health plans, health care clearinghouses, most health care providers, and their business associates, to strengthen cybersecurity protections for individuals’ electronic protected health information (ePHI). The proposals would address: changes in the […]
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February 11, 2025

EGWP marketplace medicaid Medicare

Former Chief Economist for Health Committee Warns Against Government Intervention in Private Market

The Pharmaceutical Care Management Association (PCMA) shared a blog from former policy director and chief economist for the U.S. House Committee on Ways and Means Alex Brill, where he warns Congress against misguided government interventions in the private health care market that would boost Pharma’s profits and hike health care costs for everyone else. He […]
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February 11, 2025

EGWP marketplace medicaid Medicare

perspectives

CSRxP Highlights 2025 Drug Price Hikes Outpacing Inflation

The Campaign for Sustainable Rx Pricing (CSRxP) highlighted that drug manufacturers have continued with their annual drug price increases, even as policymakers debate ways to lower drug costs for patients. In the first week of January, brand drug manufacturers raised prices on more than 250 drugs, with more increases expected throughout the month. The average […]
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February 11, 2025

EGWP marketplace medicaid Medicare

survey results

HHS OIG Report Finds Half of Hospitals Fail to Comply with Transparency Law

A new report by HHS’s Office of Inspector General (OIG) finds widespread failure among hospitals to comply with federal price transparency law, with almost half of 100 surveyed hospitals not fully compliant. The report found that many hospitals are not publishing their prices in accordance with the law, with some hospitals saying they would rather […]
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December 10, 2024

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