In The News

HHS Releases Initial Guidance for Historic Medicare Drug Price Negotiation Program for Price Applicability Year 2026

For the first time in history, Medicare will have the ability to negotiate lower prescription drug prices because of the Inflation Reduction Act, President Biden’s historic law which lowers health care and prescription drug costs. Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued initial guidance detailing the requirements and parameters—including requests for public comment— on key elements of the new Medicare Drug Price Negotiation Program for 2026, the first year the negotiated prices will apply. Alongside other provisions in the new drug law, the Medicare Drug Price Negotiation Program will strengthen Medicare’s ability to serve people currently in Medicare and for generations to come.

“For far too long, millions of Americans have had to choose between their prescription drugs and other monthly expenses,” said HHS Secretary Xavier Becerra. “President Biden is leading the fight to lower the cost of prescription drugs – and with the Inflation Reduction Act, we’re making historic progress. Through the Medicare Drug Price Negotiation Program, we will make sure seniors get a fair price on Medicare’s costliest prescription drugs, promote competition in the market, and ensure Medicare is strong for beneficiaries today and into the future.”

“Drug price negotiation is a critical piece of how this historic law improves the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “By considering factors such as clinical benefit and unmet medical need, drug price negotiation intends to increase access to innovative treatments for people with Medicare.”…

View a fact sheet - PDF on the Medicare Drug Price Negotiation Program Initial Guidance

Read the Medicare Drug Price Negotiation Program Initial Guidance - PDF

Read the Full Press Release


What’s in Biden’s Budget

CNN / By Katie Lobosco and Tami Luhby
President Joe Biden released his annual budget Thursday, outlining his policy priorities for the year ahead.
Make no mistake, the proposed budget has no chance of making it through the Republican-controlled House. But Biden’s plan will frame upcoming political battles on Capitol Hill, where the GOP has yet to unveil its own spending plan.
Biden’s budget comes out after the US hit the debt ceiling, a cap set by Congress, earlier this year. The Treasury Department is now taking extraordinary measures to allow the government to keep paying its bills. But the country could start to default on its obligations over the summer if Congress doesn’t address the debt ceiling before then. Republicans are calling for some spending cuts in exchange for voting to raise the cap, while the White House does not want to negotiate on resolving the debt limit drama.
 Many of the provisions in the budget rehash the president’s earlier proposals to expand the social safety net and to pay for it by raising taxes on the wealthy and corporations. He wants to restore the expanded child tax credit and make permanent enhanced Obamacare subsidies, both enacted in the American Rescue Plan in 2021. And he wants to provide universal free preschool, make college more affordable and establish a national paid family and medical leave program, which did not make it into prior packages when the Democrats controlled Congress over the past two years.
Biden’s spending plan also calls for shoring up Medicare and capping the price of insulin for all Americans.
The administration says these proposed policies will result in a nearly $3 trillion reduction in the deficits – the difference between what the government spends and its revenue – over the next decade.
Here’s what’s in Biden’s budget proposal

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Remote Therapeutic Monitoring: APTA Updates

While it's been more than a year since PTs were included in the list of providers able to bill for several remote therapeutic monitoring codes under the Medicare Physician Fee Schedule, details continue to be worked out — and possible changes discussed. APTA pursues those details and remains at the table for important conversations around what may or may not happen next.

Here's the latest on the PT's use of RTM under the fee schedule.

We've Updated the APTA Practice Advisory on RTM
In response to questions from members, APTA added more information to the practice advisory we published soon after the U.S. Centers for Medicare & Medicaid Services announced it would extend use of two sets of CPT codes related to RTM for use by PTs. The new information provides additional insight on billing requirements and PTA supervision.

We're Advocating for Continued Patient Access to RTM by PTs
APTA staff and member representatives participated in a recent Medicare Contractor Advisory Committee meeting to discuss the application of remote therapeutic monitoring in physical therapist practice. Generally speaking, these committee meetings are intended to be a platform for communication between providers and Medicare contractors; the Feb. 28 meeting was focused on soliciting input from subject matter experts about the use of physiologic monitoring and RTM. The aim of the meeting: To find out if it would be a good idea to establish a local coverage determination for these services. APTA made the case for no LCD, with our representatives sharing the association’s position that an LCD could interfere with patient access to these important services. APTA will submit comments as a follow-up to the call.

We're Working to Clear up Confusion Among MACs Around RTM Codes
APTA is communicating with Medicare Administrative Contractors — aka MACs — to address an apparent error in claims processing related to denials of services that should be covered. Specifically, since Jan. 1, 2023, when facilities have submitted claims for RTM on a UB-04 claim form, the MACs have accepted claims for codes 98975, 98976, and 98977 but denied codes 98980 and 98981, asserting that they're non-covered services. This is incorrect. APTA reached out to the MACs and is working with a representative from the Critical Inquiries Unit to address the error. APTA staff will provide updates as available.


Exercise Found to Decrease Suicide Attempts in Those with Mental and Physical Illness

A new study from the University of Ottawa's Faculty of Medicine found patients with mental or physical illness were able to successfully adhere to exercise regimes despite previous thinking, resulting in decreased suicide attempts.

The findings cast doubt on the misconception that patients suffering from mental or physical illness are not motivated to participate in a physical exercise regime, which has similar efficacy to antidepressants and cognitive behavioral therapy in the treatment of depression. It's effect on suicidal behaviors, however, was unclear.

"This misconception has led to primary care providers under-prescribing exercise, resulting in further deterioration of patients' mental and physical health," says Dr. Nicholas Fabiano, a psychiatry resident and lead author of the study with medical student Arnav Gupta.

"The findings of this study 'debunk' this belief as exercise was well tolerated in those with mental or physical illness. Therefore, providers should not have apprehension about prescribing exercise to these patients."

Under the supervision of Dr. Marco Solmi and Dr. Jess Feidorowicz from the Department of Psychiatry, Fabiano and Gupta evaluated 17 randomized control trials with over 1,000 participants to deduct their findings, which are published in the Journal of Affective Disorders.

A new study from the University of Ottawa's Faculty of Medicine found patients with mental or physical illness were able to successfully adhere to exercise regimes despite previous thinking, resulting in decreased suicide attempts. Credit: Media Relations, University of Ottawa

Who is Most at Risk for Long COVID?

A new study of more than 800,000 people has found that in the U.S., COVID "long haulers" were more likely to be older and female, with more chronic conditions than people in a comparison group who—after getting COVID—did not have diagnosed long COVID or any of the symptoms associated with long COVID. The findings are published in the March issue of Health Affairs.

The national study, which focused on people with private insurance or Medicare Advantage coverage, aims to inform public health and clinical care by advancing the understanding of who gets long COVID.

As one of the largest studies of long COVID in the U.S. to date, in terms of the number and diversity of people studied and the length of time symptoms and diagnoses were followed, the study solidifies many previous insights about the demographics and clinical profile of people most likely to get sick.

It also provides new information to consider about the complex interaction of COVID-19 in patients with previously diagnosed chronic illnesses.

"This work in a large population helps to address the question of who is more at risk of long COVID," said Zirui Song, associate professor in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, lead author of the article.

"This may help clinicians and health care organizations screen, monitor, and treat patients more effectively. It may also help individuals, who know their own medical history, better assess their risk of long COVID and the value of protecting against getting COVID-19 in the first place," Song said.

The study's findings also indicate that symptoms of long COVID can appear or persist much longer after initial infection than many previous studies had suggested.

Most earlier work showed a peak of long COVID symptoms and diagnoses within the first six months of a person's initial COVID-19 diagnosis, the authors note, but the new research shows another, smaller peak around one year, which the authors note was significantly longer than the follow-up period of most initial studies.

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