The End of the COVID-19 PHE Draws Near

May 4th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The COVID-19 public health emergency (PHE) is set to expire in the US next week, leaving much up in the air. The pandemic-era pause on Medicare redeterminations will hit patients soon, kicking millions off of healthcare coverage. In addition, vaccines and treatments for COVID will hit the private market, although uninsured Americans will still have access to the drugs free of charge.

States Increasingly Coordinating Care for Dual Eligibles with Managed Care, FAIs, and PACE

May 2nd, 2023|Categories: Featured, Industry News|Tags: , , , , |

Dual eligible special needs plans often run up against significant difficulties coordinating care for beneficiaries. A recent analysis by the Kaiser Family Foundation (KFF) examined how states accomplish this complex task, finding that many use managed care, a Financial Alignment Initiative (FAI), or rely upon the Program of All-Inclusive Care for the Elderly (PACE).

US CMS Passes Rule Targeting Misleading Ads for Medicare Advantage Programs

April 6th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The US Centers for Medicare and Medicaid Services (CMS) has implemented a new rule to limit misleading advertisements for Medicare Advantage programs. The rule would ban companies from producing advertising that would lead consumers to believe they are official government messaging. In addition, it would force companies to name the specific plans in their advertising.

Biden, the GOP, and the Future of Medicare

March 13th, 2023|Categories: Featured, Industry News|Tags: , , , , |

As the US Congress deliberates over the Biden administration’s recently released budget proposal, uncertainty looms over the future of Medicare funding. President Biden and most Republicans have pledged not to cut funding from the program, but some outliers within the GOP are pushing for cuts. These potential cuts could take one of a three different forms, according to Kaiser Health News correspondent Julie Rovner in a new NPR interview.

Biden Administration Looks into Expanding Reach of Medicare Drug Pricing Negotiations

March 7th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

During a statement about his administrations budgetary plans, US president Joe Biden argued that more drugs should undergo Medicare pricing negotiations. In addition, he called on the process to go more quickly, considering that only a small number of drugs will be negotiated starting in 2026 under the Inflation Reduction Act.

Future of Medicare Telehealth Uncertain as End of COVID-19 PHE Nears

February 13th, 2023|Categories: Featured, Industry News|Tags: , , , |

As the May 11 end of the COVID-19 public health emergency (PHE) approaches, uncertainty surrounds the future of Medicare telehealth services. The Consolidated Appropriations Act of 2023 will preserve some of the provisions that allowed additional telehealth flexibility, but the bill doesn’t cover everything, such as prescribing controlled substances through telehealth.

Medicare Drug Price Hike Rebates Start in 2025

February 10th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The Centers for Medicare and Medicaid Services (CMS) released a draft guidance that finally sets a timeframe for drugmaker rebates for medications that increase in price faster than inflation. The program, part of the Inflation Reduction Act, will kick into action by 2025. The agency is seeking public comments on the draft guidance submitted by March 11th.

Inflation Reduction Act Could’ve Saved Medicare Billions from 2018 to 2020

February 1st, 2023|Categories: Featured, Industry News|Tags: , , , , |

A recently published study in JAMA Health Forum investigated the potential impact of the drug pricing legislation within the US Democrat’s flagship Inflation Reduction Act had it been implemented in 2018. According to the analysis, had the legislation been in place at the time, Medicare would have saved $26.5B over 2018-2020.

NAHC President Tells Home Care Providers to Keep an Eye on Medicare Advantage

January 20th, 2023|Categories: Featured, Industry News|Tags: , , , , |

At a webinar this week, the president of the National Association for Home Care & Hospice (NAHC) Bill Dombi said that Medicare Advantage plans are on the rise and that home care providers should pay attention. Dombi noted that there is a huge marketing force driving the boom, with big celebrity names behind it.

Racial Medicare Access Disparities Worsen Health Outcomes for Black Enrollees

January 5th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Research early last year found that Black patients are routinely offered less high-quality Medicare Advantage plans compared to their white counterparts. A new study builds on this, finding that the decreased access to 5-star plans has measure effects on outcomes for Black enrollees. The researchers looked at hospitalizations that would be avoidable with disease management and outpatient care covered by better plans.

Report Finds Medicare Part B Lab Test Spending Jumped $1.3 Billion in 2021

December 29th, 2022|Categories: Featured, Industry News|Tags: , , , , |

A newly released report by the Office of the Inspector General (OIG) found that Medicare Part B spending on lab testing jumped by $1.3 billion in 2021 from 2020. This 17% increase brought the total spending on laboratory tests to $9.3 billion. A key driver of the spike comes from mass utilization of COVID-19 testing.

US Department of Defense Announces TRICARE Managed Care Contracts Totaling $136 Billion

December 23rd, 2022|Categories: Featured, Industry News|Tags: , , , |

The US Department of Defense (DoD) has awarded $136 billion in TRICARE managed care support contracts. These T-5 contracts are scheduled to initiate in 2024 and will shift 6 states from the East region to the West Region. The transfer will move around 1.5 million patients, although it is not expected to have a major immediate impact on patients’ existing care plans.

Entering the Dual Eligible Market? 5 Things for Payers to Consider

December 20th, 2022|Categories: Featured, Industry News|Tags: , , , , |

Changes in the US dual eligible landscape, patients who qualify for both Medicare and Medicaid, have complicated things for payers looking to crack into the market. In a new article on Health Payer Intelligence, Kelsey Waddill discusses 5 important things for payers interested in the dual eligible market to consider beforehand to ensure market success. The first is the increasingly picky dual eligible special need plan enrollment process.

Senate Committee Unveil Draft Legislation to Make Medicare Advantage Directories for Mental Healthcare Accurate

December 5th, 2022|Categories: Featured, Industry News|Tags: , , , |

The US Senate Finance Committee has released a draft of new legislation intended to make Medicare Advantage plans update and make available certain information to patients. This information includes provider contact details and availability for new patient intake. In addition, the draft would help target pay parity in mental healthcare.

CMS Meena Seshamani – Central Player in US Drug Pricing Legislation

November 22nd, 2022|Categories: Featured, Industry News|Tags: , , , , |

A new article in Bloomberg Government highlighted the role of Meena Seshamani, director of the US Centers for Medicare & Medicaid Services (CMS), in developing the drug pricing reform. Seshamani is working to ensure that the Inflation Reduction Act actually reduces drug prices. Her efforts are being closely watched by the opposition and the pharma industry.

Drug Pricing Reform on the Back Burner in Ramp-Up to US Mid-Term Elections

November 7th, 2022|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

Although healthcare is front and center on tomorrow’s ballot in terms of abortion and Medicare, drug pricing reform has not been a key talking point in the lead-up to the US mid-term elections. This is in spite of the Democrats’ recent legislative win with the Inflation Reduction Act, which included major drug pricing reform. However, some Republicans hope to completely or partially repeal the act, including popular portions like price capping prescription costs for older adults.

US Senate Report Finds Nine States Saw Spike in Medicare Advantage Advertising Complaints

November 4th, 2022|Categories: Featured, Industry News|Tags: , , , |

The Medicare Advantage program allows patients to purchase a private insurance plan with their Medicare benefits. A report released by Senator Ron Wyden (D-OR) found that 9 of 10 states examined had an increase in complaints over private insurers engaging in unethical marketing practices targeting seniors in the program.

Alnylam Blames New US Drug Pricing Laws for Shelving of Rare Eye Disease Therapeutic

October 28th, 2022|Categories: Featured, Industry News|Tags: , , , , |

Alnylam is setting aside a clinical trial of its therapeutic Vutrisiran for a rare eye disease due to the looming US drug pricing reforms, according to the company. The RNA-based treatment for Stargardt disease is currently used in another rare disease but would not face Medicare pricing negotiations because the law only targets newly approved drugs. Approval of the treatment for Stargardt would allow the government to negotiate the price of Vutrisiran for that indication.

HHS Takes Loss in 340B Case and Addresses Family Glitch in ACA

October 19th, 2022|Categories: Featured, Industry News|Tags: , , , , |

A US District Judge has sided against the Department of Health and Human Services (HHS) in a case regarding payouts to hospitals for its 340B program. Hospitals will start receiving full payments for qualifying drug claims by year’s end. In addition, the agency has addressed a glitch in the ACA marketplace.

New Study Finds Medicare Part D Prices Vary Widely by Location

October 10th, 2022|Categories: Featured, Industry News|Tags: , , , |

A new study from Chapter has found that the prices Medicare Part D patients pay for prescription drugs varies wildly from place to place. These costs can add up, with some patients paying thousands of dollars more than others simply based on geography. The study was performed prior to the passage of US drug pricing reform in the Inflation Reduction Act

New Bipartisan US Bill to Limit CMS from Treating All Amyloid Therapies the Same

October 7th, 2022|Categories: Featured, Industry News|Tags: , , , |

A bipartisan group in the US congress is looking to pass a bill to limit the Centers for Medicare and Medicaid Services (CMS) from lumping in all amyloid-targeted drugs with the controversial Alzheimer’s drug Aduhelm. The move comes as two new amyloid-targeted therapies have shown promising results in slowing cognitive decline.

Report Finds 1,200+ Drug Prices Outstripped Inflation

October 7th, 2022|Categories: Featured, Industry News|Tags: , , , , |

A new report finds that over 1,200 prescription drugs had price hikes that outpaced inflation this year. Fortunately for patients, pharma companies will have to provide a rebates to the Centers for Medicare and Medicaid Services (CMS) for drugs that increase in price faster than inflation for Part B and Part D recipients.  

New Medicare Advantage Turnover Rates Might Be the Tip of the Iceberg

October 5th, 2022|Categories: Featured, Industry News|Tags: , , , |

Previous estimates of enrollee turnover in Medicare Advantage plans may be significantly lower than reality, according to a paper published in the AJMC. The authors examined retrospective Medicare enrollment data from 2012-2017 and found that over 15% changed insurers in the first year after enrollment, with almost half changing within five years.

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