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Toward that end, we proposed in the CY 2026 OPPS/ASC proposed rule to replace the estimated allowed amount with the median allowed amount and to add the 10th and 90th percentile allowed amounts, requiring hospitals to encode actual dollar values they have received for an item or service when the payer-specific negotiated charge is based on an algorithm or percentage

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Which pharmacy do you use, and can you provide their FDA registration information? Should provide specific pharmacy name(s) and be willing to verify registration

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This will require Medco to raise mail order prices to compensate for these losses, thus undermining the justification for exclusionary practices such as mandatory mail order and mail order only 90-day prescriptions

Cycle: 12 weeks on, 4 weeks off