“Surprise billing” occurs when a patient unknowingly receives care from a provider outside of their insurance network and the provider subsequently bills the patient for the amount not covered by their insurer. As many states have acted to hold patients harmless – which means that the patient is not liable for the billed amount – Congress continues to debate the best approach to resolve this issue for federally regulated insurance markets.

Health care was a primary interest among voters in the 2016 and 2018 elections, as concerns about access and costs continued to grow. If you’ve been brave, or foolish, enough to follow the political campaigns underway for the 2020 election you’ve likely noticed that health care continues to be a focal point in our politics. Alongside the ongoing debate about the future of the Affordable Care Act, there has been a new development in the  debate about drug prices.

On January 12, URAC submitted comments in response to the Centers for Medicare and Medicaid Services’ (CMS) proposed rule for Medicare Advantage. As part of the proposed rule, CMS requests feedback regarding the role that accreditation, namely accreditation of specialty pharmacies, plays in Part D. CMS noted anecdotal concerns that have been reported regarding the potential limiting nature of Part D contracts that require pharmacies to maintain Specialty Pharmacy Accreditation.