8legs: Centers for medicare & medicaid services

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#1 out of 2

Medicare added 15 drugs to its latest price negotiation list, expanding government leverage over pharma pricing.
Pfizer, Novartis and Lilly drugs are now part of the government’s next round of price talks.
Any negotiated prices would not take effect until 2028, limiting immediate revenue impact.
Medicare targets large, established drugs with steady cash flow to pressure pricing long-term.
The move signals ongoing pricing pressure for top pharma brands amid federal negotiation.
The article emphasizes a broader trend of government influence over drug pricing.
The Reuters-originated piece notes a shift in Medicare negotiations impacting major brands.
Drugs named include Botox, Orencia, and Biktarvy among others in the list.
The article cites Medicare beneficiary usage and spending associated with the drugs on the list.
The timing detail clarifies no price changes until 2028 despite ongoing negotiations.

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#2 out of 2

CMS proposes flat 2027 Medicare Advantage rates and new payment changes, prompting industry pushback.
CMS would restrict chart reviews that add diagnoses to patient records to boost payments.
Kaiser Permanente settlement cited as evidence overpayments through chart reviews.
Experts say chart reviews have driven billions in overpayments for more than a decade.
Industry warns that holding rates flat could lead to benefit cuts for seniors.
CMS says the changes aim to ensure more accurate payments and protect taxpayers.
Government auditors have repeatedly found chart reviews add diagnoses, not delete.
Medicare Advantage enrollment has grown to about 34 million members.
Lawmakers warn about potential senior benefit reductions if rates stay flat.
CMS plans to issue a final decision on rates and provisions by early April.

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