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Home » Topics » Regulatory » CMS

CMS
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Cholesterol plaque in artery

Cleerly seeks US Medicare coverage of AI-enabled plaque analysis

June 3, 2024
By Mark McCarty
New York-based Cleerly Labs Inc., petitioned several U.S. Medicare administrative contractors for coverage of the use of the company’s artificial intelligence product for analysis of CT coronary arteries to evaluate the disease burden of plaque.
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Medicare puzzle

​Abbott seeks US Medicare national coverage for Cardiomems system​

May 21, 2024
By Mark McCarty
A renewed focus on telehealth and telemedicine may be pumping new life into remote patient monitoring for heart failure, which seems to be the case for the Cardiomems device by Abbott Inc.
Read More
Gavel with whistle

Hospital hit for violating US Medicare rules for TAVR devices

May 20, 2024
By Mark McCarty
U.S. Medicare coverage of transcatheter aortic valve replacement devices requires the use of team medicine for patient selection purposes, which seems to have served as a tripwire for Cape Cod Hospital (CCH) in Hyannis, Mass. Federal agencies forged an agreement with CCH that included a $24 million fine for failure to appropriately screen patients for the procedure, an event that serves as a reminder that non-compliance with Medicare rules can trigger enforcement actions by other agencies.
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CMS wants more info for Medicaid price stacking rule

May 16, 2024
By Mari Serebrov
The U.S. Centers for Medicare and Medicaid Services (CMS) is rethinking its proposed “stacking rule” for determining best price in the Medicaid program.
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CMS on deck for round 2 of US Rx price negotiations

May 6, 2024
By Mari Serebrov
With round 1 not yet completed, the U.S. Centers for Medicare & Medicaid Services (CMS) already is prepping for round 2 of the Medicare negotiations mandated by the 2022 Inflation Reduction Act. While the negotiation process will expand to Part B drugs in the future, round 2, like the first cycle, will be limited to single-source Part D drugs that account for some of the highest Medicare expenditures. However, the number of drugs selected for the next cycle could grow from the current 10 to up to 15
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Dollar signs in blister packs

Two more challenges to US Rx price negotiations dismissed

April 30, 2024
By Mari Serebrov
The U.S. government chalked up another win April 29 against the constitutional challenges to the Inflation Reduction Act’s provision mandating direct Medicare price negotiations for selected prescription drugs.
Read More
Medicare puzzle

US Medicare may tighten coverage for leg, foot ulcer treatments

April 30, 2024
By Mark McCarty
U.S. Medicare coverage of products for leg and foot ulcers has undergone a second review in less than a year thanks to pushback from stakeholders after the August 2023 issuance of proposed non-coverage policies for more than 100 cell and tissue-based products.
Read More
Bristol Myers Squibb sign

With Bristol Myers’ latest cuts, biopharma layoffs reach 7,800+

April 25, 2024
By Karen Carey
After investing $24 billion in three major acquisitions earlier this year, Bristol Myers Squibb Co. said April 25 it would cut 2,200 employees and discontinue 12 programs in an effort to save $1.5 billion and put the company on track for growth by the end of the decade. The number of jobs lost represent 28% of all biopharma jobs lost so far in 2024 – 7,834, as announced by 82 companies. There were 17,424 jobs lost at 185 companies in 2023 and 18,500 jobs lost at 123 companies in 2022, according to BioWorld data.
Read More
Needle with drop

Alvotech-Teva biosimilar approved, impact of negotiations looms

April 17, 2024
By Mari Serebrov
Having addressed the manufacturing issues that resulted in a few complete response letters, Alvotech Holdings SA and Teva Pharmaceutical Industries Ltd.’s biosimilars partnership is now on a roll, with the U.S. FDA approving the team’s second biosimilar, Selarsdi, less than two months after approving the first one, Simlandi, as an adalimumab interchangeable.
Read More
U.S. at night from space with circuit board overlay

Telehealth legislation again on tap in US House of Representatives

April 17, 2024
By Mark McCarty
Telehealth received a much-needed boost from the COVID-19 pandemic, but normal reality has settled in and a number of telehealth bills have surfaced in the U.S. House of Representatives. However, Rep. Brett Guthrie (R-Ky.) advised other members of the House that a recent extension of temporary Medicare telehealth coverage added $2 billion to Medicare spending, a fact which he said forces legislators to ensure that “whatever we move out of committee is paid for.”
Read More
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