Tara enjoys working with managed care organizations, pharmaceutical services providers such as PBMs, and integrated delivery systems, and companies that invest in them, on matters relating to compliance with federal health care program regulations, federal and state fraud, waste and abuse laws and plan benefits.
She works closely with Medicare Advantage Organizations (MAOs) and Medicare Part D Plan Sponsors, including Employer Group Waiver Plans (EGWPs), and first tier and downstream entities to address regulatory and compliance matters that arise as a result of participating in Medicare Parts C and D. Tara often advises clients on matters relating to plan bids, medical loss ratio reporting, drug pricing in both Medicare Part B and Part D and direct and indirect remuneration (DIR) reporting. She regularly counsels clients regarding risk adjustment systems and practices needed to support them. Tara also actively engages with CMS on behalf of clients on many matters.
She also works closely with discount medical and pharmacy plan operators (DMPOs) on matters relating to compliance with state laws and provider contracting.
Tara uses her substantive day-to-day compliance experience to assist clients in litigation matters and transactions.
Tara has extensive experience preparing and negotiating complex services agreements for and between MAOs, providers, PBMs, pharmacies, wholesalers, manufacturers, and DMPOs.
viewpoints
PBM Policy and Legislative Update — Summer 2024
July 31, 2024| Blog|
Mintz IRA Update — The Consequences and Costs of Redesigning the Part D Program
July 15, 2024 | Blog | By Tara E. Dwyer, Lauren Moldawer, David Gilboa, Samantha Hawkins, Stephnie John, Matthew Tikhonovsky
Read about the 2025 redesign of the Medicare Part D program pursuant to the Inflation Reduction Act of 2022 and how those changes impact Medicare Part D plan sponsors, beneficiaries, and manufacturers.
Mintz IRA Update — Third Edition: Q2 2024
July 15, 2024 | Blog | By Rachel A. Alexander, Theresa Carnegie, Madison Castle, Mitchell Clough, Tara E. Dwyer, David Gilboa, Xavier Hardy, Samantha Hawkins, Stephnie John, Bridgette Keller, Lauren Moldawer, Abdie Santiago, Hassan Shaikh
In ‘Third Edition: Q2 2024’ of the Mintz IRA Update, we cover updates to the Medicare Drug Price Negotiation Program being considered by CMS, developments in litigation challenging the program, the consequences and costs of redesigning the Part D program, opposition to the use of march-in rights to lower drug prices, and the growing use of state prescription drug affordability boards.
PBM Update: Special Edition - FTC 6(b) Interim Staff Report and Activity
July 12, 2024 | Alert | By Rachel A. Alexander, Tara E. Dwyer, Theresa Carnegie, Joseph Miller , Bridgette Keller, Samantha Hawkins, Hassan Shaikh, Payton Thornton
On July 9, 2024, the Federal Trade Commission (FTC) Office of Policy Planning released an Interim Staff Report titled Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. The Interim Staff Report reflects the FTC’s work since it began its 6(b) study of PBMs in June 2022. Mintz’s Health and Antitrust teams actively monitor federal and state regulatory and legislative developments in the PBM space, including those from the FTC. In this Special Edition of the PBM Policy and Legislative Update, the Mintz Health team partnered with our Antitrust colleagues to analyze the Interim Staff Report including Commissioner Melissa Holyoak’s dissenting statement. We also highlight upcoming Congressional testimony by CEOs of the three largest PBMs, as well as media reports of a forthcoming FTC action related to PBM insulin rebate practices.
The Uncertain Landscape of Medicare Agent/Broker Compensation Rules
July 11, 2024 | Blog | By Tara E. Dwyer, Xavier Hardy, Madison Castle
In the Proposed Medicare Advantage and Part D Rules for 2025, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to how Medicare Advantage organizations (MAOs) are allowed to contract with and compensate entities that provide agent/broker and enrollment services. The proposed rules were heavily disfavored by entities that provide such services, but were not widely commented on by MAOs or Part D sponsors (PDP Sponsors), which are the entities to which the rules actually apply.
Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program
June 6, 2024 | Blog | By Tara E. Dwyer, Samantha Hawkins
As part of its 2025 Medicare Advantage and Part D Final Rule (the Final Rule), the Centers for Medicare & Medicaid Services (CMS) finalized a number of regulatory changes relating to how Medicare Advantage (MA) plans offer supplemental benefits and how they communicate such benefits to plan members. As previewed in the Proposed 2025 Rules, the Final Rule outlines CMS’s intentions to (i) more closely monitor the supplemental benefits that a Medicare Advantage organization (MAO) offers and categorizes as "Special Supplemental Benefits" for the Chronically Ill (SSBCI) and (ii) require MA plans to send annual notices to MA plan enrollees regarding their available supplemental benefits.
PBM Policy and Legislative Update — Winter 2024
May 2, 2024 | Blog | By Theresa Carnegie, Tara E. Dwyer, Rachel A. Alexander, Bridgette Keller, Madison Castle, David Gilboa, Xavier Hardy, Abdie Santiago, Hassan Shaikh, Sophia Temis
Mintz is pleased to present its quarterly publication, PBM Policy and Legislative Update. This edition builds upon prior issues and summarizes activity from October through December 2023 that affects the PBM industry and will specifically highlight (i) federal legislative and enforcement updates, (ii) state legislative updates and litigation, (iii) other industry news, and (iv) Inflation Reduction Act (IRA) updates.
Unpacking CMS’s 2025 DSNP Changes: Considerations for Medicare Advantage Organizations
May 1, 2024 | Blog | By Tara E. Dwyer, Lauren Moldawer, Madison Castle
As part of its 2025 Medicare Advantage and Part D Final Rule (the Final Rule), the Centers for Medicare & Medicaid Services (CMS) made a number of enrollment changes impacting dual eligible special needs plans (DSNPs). The goal of these changes is to promote integration of Medicaid and Medicare services for full benefit dually eligible (FBDE) individuals. While stakeholders support the overall goal of better integration, the new policies are complex and may discourage Medicare Advantage Organizations (MAOs) from participating in Medicaid managed care programs in certain regions. They also highlight how a federal DSNP regulation that is tied to how a state contracts with entities that offer Medicaid benefits can result in different impacts in different states.
CMS Publishes Final Rules Implementing Part C and Part D Program Changes
April 23, 2024 | Blog | By Tara E. Dwyer, Bridgette Keller
On April 23, 2024, the Centers for Medicare & Medicaid Services (CMS) published final rules setting forth Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024--Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program…et al. These sweeping final rules finalized many changes that were introduced in the Proposed 2025 Rules and other changes that were proposed in the Proposed 2024 Rules. The rules will implement changes related to many areas, including, for example, Star Ratings, marketing and communications standards and requirements, agent/broker compensation, health equity, dual eligible special needs plans (D-SNPs), Part D formularies, utilization management, and the Medicare Advantage and Part D application process.
CMS Releases Part Two of Guidance for the Inflation Reduction Act’s Medicare Prescription Payment Plan
February 27, 2024 | Blog | By Tara E. Dwyer, Lauren Moldawer, Madison Castle
On February 15, 2024, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Prescription Payment Plan Draft Part Two Guidance (Part Two Guidance) as part of the Inflation Reduction Act’s (IRA) efforts to tackle high prescription drug costs. The Medicare Prescription Payment Part Plan (the Program), which was previously referred to as the “OOP Smoothing Program”, was established as part of the IRA and requires Part D plans (PDPs) to offer their members an option to pay for out-of-pocket (OOP) prescription drug costs in monthly capped payments, as opposed to all at once, at a pharmacy. Meaning, for members who opt-in to the Program, they will pay $0 at the pharmacy and the PDP must pay the pharmacy the full cost-sharing amount of the drug and then bill the member the amount of the cost-sharing over the remainder of the calendar year.
News & Press
The Best Lawyers in America 2025 Recognizes 184 Mintz Attorneys across 56 Practice Areas
August 15, 2024
187 Mintz attorneys have been recognized by Best Lawyers® in the 2025 edition of The Best Lawyers in America©. Notably, three Mintz attorneys received 2025 “Lawyer of the Year” awards, and 64 firm attorneys were included in the 2025 edition of Best Lawyers: Ones to Watch.
PBM Takeaways From Proposed Telehealth Flexibility Bill
June 18, 2024
Mintz announced today that 42 of its practices and 83 of its attorneys earned recognition in the 2024 edition of Chambers USA, a guide to the country’s leading law firms. Of those included in the guide, 18 attorneys and seven practice areas were awarded Chambers’ highest ranking, Band 1. The firm obtained new listings in three practice areas and 10 of its lawyers were recognized for the first time.
Mintz Facilitates $3.7 Billion Deal For The Cigna Group
January 31, 2024
The Cigna Health Group signed a deal selling its Medicare businesses to Health Care Service Corporation (HCSC) for $3.7 billion. A Mintz team led by Tara Dwyer and Lauren Moldawer acted as regulatory counsel to The Cigna Group on the sale. In the deal, which is expected to close in the first quarter of 2025, HCSC will acquire Cigna’s Medicare lines including Medicare Advantage, Medicare supplement, and Medicare drug plans, as well as CareAllies, a unit that works with physician groups and other healthcare providers.
Lawsuits, Tax Fuel Doubt As Medicare Preps Drug Pricing Talks
August 25, 2023
Member Tara Dwyer spoke to Bloomberg Law and discussed potential roadblocks delaying Medicare's plans for negotiating lower drug prices.
Mintz is pleased to announce that 120 firm attorneys have been recognized as leaders by Best Lawyers® in the 2024 edition of The Best Lawyers in America©.
'Many Legal Challenges' Loom As HHS Inks $4.7B Audit Rule
January 30, 2023
Mintz Member Tara Dwyer was quoted in Law360 examining the release of a Health and Human Services rule which prompted backlash and predictions of litigation.
Supreme Court Holds that ERISA Does Not Preempt Arkansas PBM Law: The Impact on Employer Sponsored Health Plans
February 5, 2021
Drug Intermediaries Threaten Lawsuits to Preserve Cut of Prices
November 23, 2020
Mintz Practice Groups and Attorneys Garner Top Rankings in 2020 Edition of The Legal 500 United States
June 12, 2020
Proposed changes to Medicare Advantage audits could put insurers on the hook for billions
October 29, 2018
Mintz Promotes Six Attorneys to Member
May 23, 2018
Events & Speaking
Legal, Regulatory, and Compliance Summit on Medicare Advantage
American Conference Institute
Nashville, TN
3rd Annual Mintz /ML Strategies Pharmacy & Pharmaceutical Industry Summit
Mintz and ML Strategies
Boston, MA
Recognition & Awards
Best Lawyers in America: Health Care (2024, 2025)
Chambers USA: District of Columbia – Healthcare (2024)
Included on the Washington DC Super Lawyers Rising Stars: Health Care list (2016 - 2021)
The Legal 500 United States for Healthcare: Service Providers (2019-2020, 2024)
Order of the Coif
ABA-BNA Award for Excellence in the Study of Health Law