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Over the 3 calendar quarters (4Q2023, 1Q2024, and 2Q2024), our proposed approach for calculating the payment limit for biosimilars with only negative or zero ASP and the two alternative approaches would have reduced program expenditures by at least $821,599.473, $914,463.917, and $1,148,055.145, respectively
Certain policies, including both existing policies and the proposed new policies described in this proposed rule, rely upon the authority granted in section 1899(i)(3) of the Act to use other payment models that the Secretary determines will improve the quality and efficiency of items and services furnished under the Medicare program, and that do not result in program expenditures greater than those that would result under the statutory payment model
As part of the Coverage to Care (C2C) initiative, CMS published the Roadmap to Behavioral Health, which defines behavioral health conditions to include mental and substance use disorders
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