CMS Announces Drug Payment Reductions with the “Most Favored Nation” Effective January 1, 2021
Visante presented a 45-minute webinar from experts Adrianne (Maxie) Friemel (Pharm.D, M.S, BCPS, CRCR) and Agatha Nolen (PhD, MS Pharm, FASHP, CRCR) on December 4th.
Centers for Medicare and Medicaid Services (CMS) announced the long-awaited seven year Most Favored Nation (MFN) model as an interim final rule. Published in the Federal Register on Nov. 27, the rule will potentially decrease payment for 50 expensive drugs provided in hospital outpatient departments and physician offices starting January 1, 2021
Who is impacted?
All beneficiaries enrolled in Medicare Part B who have Medicare as a primary payer and are not covered under Medicare Advantage or another group health plan are included and receive an MFN Model Drug from an MFN provider. Providers are generally those who submit a claim for a separately payable drug under Part B that is an MFN Model drug, e.g., physician offices, outpatient hospital departments (including on- or off- campus provider-based departments) and Ambulatory Surgery Centers.
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