Medicare Coverage Strategies: Impact of the MMA and PBMs

American Health & Drug Benefits ™ has been created to act as an ideological melting pot focusing on health and drug benefit decision makers, as well as those who may affect or may be affected by those decisions. By engaging in conversations with payors, regulators, employers, and other stakeholders, our journal hopes to enable decision makers to view the impact of benefit designs from as many perspectives as possible. Through this open dialogue, we hope that better decisions may be made, and that the greater healthcare marketplace will be positively impacted. In following our editorial mission, American Health & Drug Benefits ™ has sought thought leaders who have influenced and will continue to influence the healthcare marketplace. During a fall visit to Washington, DC, Dr. Joseph Antos was kind enough to host a visit to the American Enterprise Institute and provide his thoughts to Robert Henry, editor-in-chief, on how the Centers for Medicare & Medicaid Services (CMS) exerts its influence on drug coverage in the wake of the Medicare Modernization Act (MMA) and in the face of evidence-based medicine standards. Following a chronology of CMS's role from its inception to current events, Dr. Antos offers a lively insight into CMS's strategy and its tactical effects on the American healthcare system.