Legislation & Regulation

On March 10, AMCP submitted comments to CMS regarding a Notice of Proposed Rulemaking (NPRM) on Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children’s Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals. AMCP's comments address whether CMS should consider policies to require payers to include information about prior authorizations for drugs on the Patient Access API, the Provider Access API, and the Payer-to-Payer API and how information on the APIs might interact with existing prior authorization requirements.

With changing industry trends and new legislation, having robust Real World Evidence (RWE) for your organization is more important than ever. In this sponsored webinar, leaders at the forefront of healthcare discuss their experiences with regulatory submissions and selecting quality data.

On March 6, AMCP submitted a comment letter in response to the Centers for Medicare and Medicaid Services' Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. AMCP's comments support CMS' proposed Universal Foundation and commitment to advancing health equity, as well as the use of inclusive and gender-affirming approaches to HEDIS measures.

On March 3, AMCP joined 11 other pharmacy associations in a sign-on letter addressing pharmacy priorities following the end of the COVID-19 Public Health Emergency (PHE) in May. The letter, addressed to HHS Secretary Xavier Becerra and White House COVID-19 Response Coordinator Dr. Ashish Jha, requests the Administration take immediate action to ensure continued access to certain critical patient care services delivered by pharmacists under the COVID-19 PHE.

On Dec. 27, the Centers for Medicare and Medicaid Services (CMS) unveiled a Notice of Proposed Rulemaking (NPRM) on improvements to the Medicare Advantage and prescription drug programs. In a Feb. 13 comment letter, AMCP offers suggestions for strengthening CMS' Medication Therapy Management program, accessible format requirements, and approved formulary, as well as proposals to increase health equity in Medicare Advantage.

On Dec. 2, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) on Essential Health Benefits (EHB). The RFI sought input on a proposed switch to the U.S. Pharmacopeia Drug Classification (USP DC) standard for defining the EHB prescription drug category. AMCP's comments, submitted on Jan. 31, urge CMS to refrain from switching to any alternative prescription drug classification standard.

On Dec. 21, the Department of Health and Human Services released a proposed rule titled "Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024." On Jan. 30, AMCP submitted comments which oppose two issues from the proposed rule; continuing formulary tier limitations for standardized plan options and new limits on the number of non-standardized plan options that issues may offer through the federal Marketplace.

On Jan. 27, AMCP, along with 76 other healthcare organizations, signed on to a consensus statement on health equity. In the statement, signatories recognize health inequity as a complex issue and reaffirm their commitment to take action within their organizations to reduce health inequities for the broader population.