by Yvonne Tso, PharmD, MBA Every year, the Centers for Medicare & Medicaid Services (CMS) informs stakeholders of the methodological...

by Yvonne Tso, PharmD, MBA Beginning in CY 2025, a statutory requirement[1] takes effect for Part D sponsors to provide all Part D...

by Yvonne Tso, Senior VP, PharmD, MBA It has been said many times and in many ways – fraud, waste and abuse (FWA) prevention, detection...

by Yvonne Tso, Senior VP, PharmD, MBA The prescription drug program, or Part D, as we know it will have a different look and feel in...

by Julie Mason, President As you are probably aware, CMS has announced that it will be conducting audits of the prior authorization...

by Yvonne Tso, PharmD, MBA This article is the second in a series that highlights proposed changes for 2025 by the Centers for Medicare &...

By Yvonne Tso, PharmD, MBA On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-4205-P)...

By Julie Mason, Integritas President CMS notified MA plans this week that it will be conducting audits of the new prior authorization and...

by Yvonne Tso, PharmD, MBA Every year in October, the Centers for Medicare & Medicaid Services (CMS) publishes a readiness checklist for...

by Yvonne Tso, PharmD, MBA In August 2023, CMS’ Fraud Investigations Group released 16 fraud case announcements via HPMS to alert all...

by Yvonne Tso, PharmD, MBA Medicare Advantage Organizations (MAOs) are about a month away[1] from executing their contracts with the...

by Yvonne Tso, PharmD, MBA Since passage of the Inflation Reduction Act (IRA) in August 2022, the Centers for Medicare & Medicaid (CMS)...

by Yvonne Tso, PharmD, MBA On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published the draft Advance Notice of...

by Yvonne Tso, PharmD, MBA On January 30, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule (CMS 4185-F)...

CMS program audits aren't for the faint of heart; they are stressful, time-consuming, labor-intensive, and can impact the future of your...

by Yvonne Tso, PharmD, MBA The House of Representatives is proposing legislation (H.R. 3173) to streamline prior authorization...

by Yvonne Tso, PharmD, MBA On August 3, 2022, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Parts...

By Yvonne Tso, PharmD, MBA All Medicare Advantage and Prescription Drug Plans (collectively, Sponsors) submit prescription drug event...

by Yvonne Tso, Senior Vice President of Pharmacy, Pharm.D., MBA The Centers for Medicare & Medicaid Services (CMS) launched a new cycle...

by Yvonne Tso, Pharm. D., MBA On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and...