(Jan. 30, 2025) – MLN Connects Provider eNews from the Medicare Learning Network
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews:
CMS Announces Third Cycle of Medicare Drug Price Negotiation, Including Part B Drugs
This week, the Centers for Medicare and Medicaid Services announced the selection of 15 high-cost prescription drugs covered under Medicare Part D and drugs payable under Medicare Part B for the third cycle of the Medicare Drug Price Negotiation Program. One drug, Tradjenta, previously negotiated during the first round, was also selected for renegotiation. Negotiations with participating drug companies will occur in 2026, and any negotiated and renegotiated prices will become effective Jan. 1, 2028. The selected drug list for the third cycle of negotiations is:
- Anoro Ellipta
- Biktarvy
- Botox; Botox Cosmetic
- Cimzia
- Cosentyx
- Entyvio
- Erleada
- Kisqali
- Lenvima
- Orencia
- Rexulti
- Trulicity
- Verzenio
- Xeljanz; Xeljanz XR
- Xolair
Drug companies with a selected drug for the third cycle of negotiations will have until Feb. 28, 2026, to decide whether to participate. For more information, see the CMS Fact Sheet.
CMS Releases CY 2027 Advance Notice of Methodological Changes for Medicare Advantage
The Centers for Medicare & Medicaid Services released the advance notice of methodological changes for Medicare Advantage, capitation rates, and Parts C and D payment policies for calendar year 2027. Medicare Advantage plan payments are expected to increase by 0.09 percent as compared to calendar year 2026. The changes also include revisions to the risk adjustment methodology and Parts C and D Star Ratings.
CMS Seeks Comment on Ensuring Domestic Supply of PPE and Essential Medicines
The Centers for Medicare & Medicaid Services released an advance notice of proposed rulemaking and is soliciting comments on how to "strengthen the American-made supply chain for personal protective equipment and essential medicines."
CMS is building on lessons learned during the COVID-19 public health emergency by "exploring ways to reduce reliance on foreign-made medical supplies and enhance the nation's readiness for future emergencies while supporting American workers and manufacturers." CMS is seeking comments on the following:
- Useful alternatives to self-attestation on the Medicare cost report used to obtain designation approval
- Definition of "domestic" for personal protective equipment and essential medicines
- Criteria for determining a sufficient supply of PPE and essential medicines
- Barriers hospitals may face
- Considerations for phasing in the policy over time
Public comments must be received within 60 days of the date of publication in the Federal Register.
U.S. House of Representatives Passes FY 2026 Appropriations
The U.S. House of Representatives passed two appropriations measures that would fund the government through federal fiscal year 2026. The Department of Homeland Security Appropriations Act (HR 7147) was passed by a vote of 220 to 207. The Consolidated Appropriations Act, 2026 (HR 7148) passed overwhelmingly by a vote of 341 to 88. HR 7148 includes funding and health care extenders, including the following:
- Enhances Medicare low-volume payment adjustments through Dec. 31, 2026
- Extends Medicare-dependent hospital program through Dec. 31, 2026
- Extends certain telehealth flexibilities through Dec. 31, 2027
- Extends Hospital-Care-at-Home waiver through Sept. 30, 2030
- Prevents Medicaid DSH funding cuts through Sept. 30, 2027