Medicare seeks to tighten drug program rules to fight fraud

Jan 7 2014

Draft regulations issued Monday would overhaul the prescription drug program and could save up to $1.3 billion over five years. 

The Hill: New Healthcare Regs Target Medicare Fraud
Hundreds of pages of draft regulations issued Monday would overhaul the federal Medicare Advantage and Part D prescription drug programs, tackling fraud and saving an estimated $1.3 billion over five years, the Obama administration said. The U.S. Centers for Medicare and Medicaid Services (CMS) contends the sweeping proposed rule would strengthen consumer protections, while both cutting costs and improving care for enrollees in the programs (Goad, 1/6).

ProPublica: In A Major Shift, Medicare Wants Power To Ban Harmful Prescribers
Medicare plans to arm itself with broad new powers to better control -; and potentially ban -; doctors engaged in fraudulent or harmful prescribing, following a series of articles by ProPublica detailing lax oversight in its drug program (Weber and Ornstein, 1/6). 

CQ HealthBeat: CMS Proposes Rule Cutting Protected Formulary Drugs
The Centers for Medicare and Medicare Services is proposing a rule that would no longer require certain drugs to be included on the formularies of plans providing prescription drug coverage to Medicare beneficiaries. Under the proposed criteria, CMS would require formulary inclusion of all medications in the antineoplastic, anticonvulsant, and anti-retroviral drug classes, with certain exceptions (1/6).