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    • CMS Finalizes Withdrawal of AMP Regulations; Leaves Many Questions UnansweredNovember 10th, 2010

      By Alan M. Kirschenbaum – The Centers for Medicare & Medicaid Services (“CMS”) has finalized the withdrawal of its regulations on the calculation of Average Manufacturer Price (“AMP”) and the determination of federal upper limits.  As we previously reported, CMS is withdrawing these regulations because they …

    • TRICARE Reissues Retail Pharmacy Refund Rule Largely UnchangedOctober 18th, 2010

      By Alan M. Kirschenbaum – After conducting a regulatory exercise mandated by court order, the Department of Defense (“DoD”) on Friday issued a regulation that is virtually identical to a regulation issued in March 2009 to implement its TRICARE retail drug refund program.  As we previously …

    • OIG Enforcement Initiative Regarding AMP and ASP ReportingSeptember 29th, 2010

      By Michelle L. Butler – Yesterday, the Office of the Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a Special Advisory Bulletin regarding a new enforcement initiative to promote increased compliance by manufacturers with regard to reporting of average manufacturer prices …

    • HRSA Initiates Rulemaking to Implement Health Reform Changes to the 340B Drug Pricing ProgramSeptember 22nd, 2010

      By Jennifer B. Davis – On September 20, 2010, the Health Resources and Services Administration (“HRSA”) issued two Advanced Notices of Proposed Rulemaking and Requests for Comment (here and here) announcing its preliminary plans, and requesting stakeholder input, on how best to implement new authorities over …

    • CMS Proposes to Withdraw Medicaid Rebate AMP and Federal Upper Limit RegulationsSeptember 7th, 2010

      By Michelle Butler & Alan Kirschenbaum –   It took CMS 17 years to issue a regulation implementing the Medicaid Rebate Program, and much of that regulation is turning out to be short-lived.  On Friday, September 3, CMS published a proposal to withdraw provisions of its 2007 …

    • CMS Publishes Final Part D Coverage Gap Discount Agreements With Admonition to Act QuicklyAugust 10th, 2010

      By Michelle L. Butler & Alan M. Kirschenbaum – On August 3, CMS issued final versions of three agreements to implement the Medicare Coverage Gap Discount Program.  We previously described the guidance CMS developed with regard to this program as well as the draft agreements …

    • District Court to HHS: Failure to Consider FDA Approval in Coverage Decision is Arbitrary and CapriciousAugust 10th, 2010

      By Carrie S. Martin – On July 28, a district court in the State of Washington granted a motion for summary judgment in favor of Plaintiff which sought coverage of Medicare claims for a medical device.  International Rehabilitative Sciences, Inc. v. Sebelius, No. C08-5442-RBL (W.D. …

    • Administration Releases Two Healthcare Reform Implementation Guidances Affecting Drug ManufacturersMay 23rd, 2010

      By Alan M. Kirschenbaum – The Obama Administration took two steps on Friday to advance the implementation of health care reform, both of which are of interest to drug manufacturers.  First, CMS issued a draft agreement and final guidance on the Part D coverage gap …

    • CMS Issues Proposed Guidance on Part D Coverage Gap DiscountMay 2nd, 2010

      By Alan M. Kirschenbaum – Five weeks after the enactment of health care reform, CMS has, with surprising alacrity, issued a draft guidance on one of the provisions of the legislation that will be most costly to brand drug manufacturers – the Medicare Part D …

    • TRICARE Involves Public in its Reconsideration of Retail Pharmacy Refund ProgramFebruary 10th, 2010

      By Alan M. Kirschenbaum –       Late last year, we reported on a decision of the D.C. District Court upholding the Department of Defense’s ("DOD’s") authority to apply Federal Ceiling Price ("FCP") limitations to all prescriptions filled on or after January 28, 2008 under the TRICARE …

    • Settlement in False Claims Act Suit is no bar to suing the ConsultantDecember 1st, 2009

      By Jeffrey N. Wasserstein – We missed this interesting decision in the run-up to Thanksgiving.  Now that we’ve recovered from our tryptophan-induced sleepiness, we found this case to be of particular interest.  We previously blogged on the Cell Therapeutics Inc. (“CTI”) case.  To sum up …

    • HRSA Issues Guidance on Children’s Hospital 340B Drug Pricing ProgramSeptember 3rd, 2009

      By Michelle L. Butler – On September 1, 2009, the Health Resources and Services Administration (“HRSA”) issued a Final Notice regarding qualified children’s hospitals and the 340B Drug Pricing Program.  See 74 Fed. Reg. 45,206 (Sept. 1, 2009).  Section 340B of the Public Health Service …

    • Changes to Medicaid Rebate and DME Payment Among Cost-Saving Measures Considered by Senate Finance CommitteeMay 18th, 2009

       By Alan M. Kirschenbaum –  The Senate Finance Committee released a white paper today outlining policy options that the Committee is considering to offset the cost of upcoming health care reform legislation.  The proposed options include lifestyle taxes (e.g., alcohol excise taxes), reductions in subsidies …

    • DOD Issues Guidance on Section 703 Refund ProgramMarch 20th, 2009

      By Alan M. Kirschenbaum – Yesterday, we reported on the Department of Defense’s final regulation implementing section 703 of the National Defense Authorization Act for Fiscal Year 2008 (NDAA-2008).  The regulation establishes a framework for manufacturers to pay refunds to the government on NDA drugs dispensed …

    • TriCare TRRx Refund Final Rule: A Big Stick Disguised as a CarrotMarch 19th, 2009

      By Michelle L. Butler & Alan M. Kirschenbaum – On March 17, 2009, the Department of Defense (“DoD”) issued a final rule implementing section 703 of the National Defense Authorization Act for Fiscal Year 2008 (“NDAA-08”).  Section 703 of the NDAA-08 provides that, for any prescriptions …