Payer Blog

Recent Posts

2026 Rate Announcement: MTM Update

The 2026 Rate Announcement released on 4/7/25 included a decision from CMS not to retire the CMR completion rate measure. While CMS acknowledged stakeholder feedback opposing retirement without an outcomes-based replacement, they confirmed the measure will remain on the display page due to the expanded MTM eligibility requirements.

4 min read

Early Preview: Insights and Results from the MTM Expansion

In order to expand the population eligible for MTM, CMS modified criteria requirements by establishing an expanded list of targeted disease states and reducing the drug spend threshold.

8 min read

Final Rule Details

The Final Rule was released on April 4, 2024 detailing updates to criteria utilized for MTM Program enrollment effective January 1, 2025.

5 min read

The Top 3 Areas Payers Should Focus on to Raise the Bar in 2024

Here are three clinical areas that payers and their pharmacy care partners will need to emphasize in 2024.

6 min read

Proposed Rule Summary - Medicare Advantage 2025 Proposed Rule

The proposed rule is a detailed outline of all changes and provisions that CMS proposes to make to the Medicare Advantage program in 2025 and beyond.

5 min read

Why Payers Need Robust Medication Adherence Strategies

Let's discuss the issue of nonadherence and what payers can do to improve these numbers and help more patients.

4 min read

Pharmacy Solutions For Formulary Optimization

Formulary management can result in significant savings for health plans and combat rises in prescription drug prices.

1 min read

Outcomes Collaborates with CaringWire to Provide a New [...]

In this blog, we will discuss how Outcomes has collaborated with CaringWire.

2 min read

Unlocking the Value of Outcomes

Pharmacists are emerging as pivotal players in healthcare. They have the opportunity to provide care that expands their impact beyond dispensing meds.