2025 Healthcare Policy Shifts: PBMs, AI Denials, Orphan Drug Fees
Key 2025 healthcare updates: orphan drug waste fees, PBM lawsuits, AI claim denials, DEA telehealth rules, ICD-10 changes, and Medicare Advantage probes.
Roberta L. Buell is a Principal at onPoint Oncology Inc., specializing in oncology reimbursement. With over 23 years of experience in billing, coding, and drug therapy reimbursement, she's a nationally recognized expert and frequent speaker on regulatory and reimbursement issues. Bobbi has led more than 600 seminars since 1991 and currently serves as content director for focalPoint® and assistPoint®. Learn more about Bobbi here .
Key 2025 healthcare updates: orphan drug waste fees, PBM lawsuits, AI claim denials, DEA telehealth rules, ICD-10 changes, and Medicare Advantage probes.
Category III CPT codes track emerging tech and procedures. Learn when to use them, how they’re reimbursed, and why they may lead to future Level I code approval.
CMS clarifies complex drug administration coding for 2025: new guidance outlines when to use CPT 96401–96549 based on risk, monitoring, and staff expertise.
See the Q2 2025 HCPCS drug code updates effective April 1, 2025—new, deleted, and revised codes for Medicare billing. Full list available on BuyandBill.com
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The Comparative Report puts ASP, the Medicare payment limit, WAC and AWP for up to 15 drugs on one timeline. Ten-plus years of monthly history, per HCPCS unit.
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Trastuzumab class, seven products
Actual published ASP, Jan 2015 to Aug 2026.