Tag: dual-eligibles
In brief: PBM reform bill, dual-eligible data book, OSA-insomnia link
December 5, 2025HME News Staff
WASHINGTON – U.S. Senate Finance Committee Chairman Mike Crapo, R-Idaho, and Ranking Member Ron Wyden, D-Ore., have introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act to fix market distortions and increase transparency in federal prescription drug programs to lower patient costs at the pharmacy counter.
“Pharmacy benefit managers should not profit from overcharging patients for their prescriptions,” said...
MedPAC provides data on dual-eligibles
February 6, 2023HME News Staff
WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) and CHIP Payment and Access Commission (MACPAC) have released an updated data book, “Beneficiaries Dually Eligible for Medicare and Medicaid,” that presents information on the demographic and other personal characteristics, expenditures and health care utilization of individuals who were dually eligible for Medicare and Medicaid coverage in 2020. “We hope these data will provide a comprehensive picture of program...
CMS clarifies guidance on dual-eligibles
January 8, 2019HME News Staff
WASHINGTON - CMS has released updated guidance for state Medicaid programs on Medicare coverage for dual-eligible beneficiaries, clarifying that states do not need to require a Medicare denial for DMEPOS like incontinence supplies that the program routinely denies as non-covered, AAHomecare reports. The guidance also suggests that states consider creating a list of DMEPOS that are not covered by Medicare to expedite Medicaid coverage and payment for dual-eligibles. By doing so, states can avoid requiring...