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A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
NextSource Pharmaceuticals decided to withdraw lomustine from Medicare at the beginning of 2021. This was the first time in history that a company with a drug eligible for coverage under the Medicare Part D benefit made the decision to leave the program. In July 2021, the list price for the highest dose of lomustine was 1900% higher than it was ...
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
Doctors and Clinicians analyzed KFF data and resources from the Department of Health and Human Services to break down the common forms of insurance plans in the U.S. to help consumers navigate ...
CMS Finalizes Payment Updates for 2025 Medicare Advantage and Medicare Part D Programs, U.S. Department of Health and Human Services. Accessed September 6, 2024. Accessed September 6, 2024.
Specialty drugs patient care management is meant to be both high technology and high touch care, or patient-centered care with "more face-to-face time, more personal connections". Patient-centered care is defined by the Institute of Medicine as "care that is respectful of and responsive to individual patient preferences, needs and values".
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A study by the Government Accountability Office (GAO) found that the integration of Medicare and Medicaid benefits generally improves the care provided to dual-eligibles but does not lead to Medicare savings or a reduction in costly Medicare services (i.e., emergency room visits, hospital admissions, and 30-day risk-adjusted all-cause ...