Drug Costs

How are Medicare plans lowering drug costs for beneficiaries?

April 9, 2024 - Affordable access to prescription drugs is a necessity for managing chronic and acute conditions and staying healthy. However, as drug costs rise, both affordability and accessibility are dwindling. Over 80 percent of surveyed adults said the cost of prescription drugs is unreasonable, according to 2023 KFF data. Younger individuals who made less money and took four or more medications...

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Massachusetts residents delay services due to high healthcare costs

by Victoria Bailey

High healthcare costs are burdening Massachusetts residents, with many delaying care due to prices, according to a survey from Beacon Research commissioned by Blue Cross Blue Shield of Massachusetts...

How Payers and Pharmacy Benefit Managers Work Together to Lower Costs

by Victoria Bailey

As prescription drug spending rises in the United States, healthcare stakeholders and policymakers constantly look for ways to curb costs. Many payers turn to pharmacy benefit managers (PBMs), which aim to negotiate lower drug prices with...

US Drug Prices Are 8x the Cost in Peer Countries for Some Drugs

by Kelsey Waddill

Despite efforts to reduce drug costs through Medicare negotiation for 10 common medications, the US still pays more for these drugs than almost any other nation, even after factoring in discounts and...

HHS Releases First 10 Drugs Eligible for Medicare Price Negotiation

by Victoria Bailey

Updated 10/3/2023: This article has been updated to include the drug companies' decisions to participate in the negotiation process. HHS has announced the first ten drugs that will be available...

CMS Announces Monthly Payment Option for Out-of-Pocket Part D Costs

by Victoria Bailey

CMS has released draft guidance detailing a new program allowing Medicare beneficiaries to pay out-of-pocket Part D costs in monthly installments. The Medicare Prescription Payment Plan is required...

Blue Shield of CA Launches Value-Based Pharmacy Model to Lower Drug Costs

by Victoria Bailey

Blue Shield of California (Blue Shield) has launched a value-based pharmacy model to improve member access to affordable prescription drugs. The payer has partnered with five companies to deploy the...

Generic Insulin Drug Pricing, Access Still Pose Problems for Uninsured

by Kelsey Waddill

Following up on a promise that Eli Lilly made in 2019, the offices of Senators Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), and Raphael Warnock (D-GA) conducted a survey on the drug pricing and...

UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment

by Kelsey Waddill

UnitedHealth Group’s earnings call for the second quarter of 2023 featured revenue growth due to strong performance from the healthcare company’s insurance arm, UnitedHealthcare, and its...

CMS Proposed Rule Addresses Drug Cost Transparency in Medicaid

by Victoria Bailey

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that aims to increase the transparency of prescription drug costs in Medicaid. “This proposed rule prioritizes...

Medicare Coverage of Weight Loss Drugs May Reduce Access Disparities

by Victoria Bailey

Given the substantial costs, Medicare coverage of weight loss drugs could lead to higher Medicare spending but may help reduce access disparities, according to a KFF policy watch. GLP-1 (glucagon-like...

How Specialty Pharmacies Compare to Provider, Hospital on Drug Pricing

by Kelsey Waddill

AHIP released updated data on drug pricing increases, comparing hospital costs and the prices that physician offices pay compared to specialty pharmacies. The payer organization analyzed price...

AHIP Argues In Favor of the Copay Coupon Accumulator Rule

by Kelsey Waddill

AHIP submitted an amicus brief in favor of the HHS copay coupon accumulator rule, which would allow states to decide whether pharmaceutical manufacturers’ copay coupons should contribute to...

Employer-Sponsored Health Plans Pay More for Drugs than Medicare

by Victoria Bailey

Employer-sponsored health plans paid more than Medicare for most physician-administered drugs with the highest use and the highest spending, according to data published in JAMA Health Forum. In...

Centene Managed Care Plans Will Pay Medi-Cal $215M for Overcharges

by Victoria Bailey

Centene must pay Medi-Cal, California’s state Medicaid program, over $215 million to settle allegations that it two of its managed care plans overcharged the program by reporting inaccurate...

How the Inflation Reduction Act Will Impact Employers, Health Plans

by Victoria Bailey

While the Inflation Reduction Act of 2022 will likely improve member retention and curb healthcare costs for enrollees in the individual market, the impact on the employer market is less clear. As Medicare negotiates lower drug prices,...

63% of Medicare Beneficiaries Paid Full Generic Drugs Cost in 2020

by Sarai Rodriguez

Under Medicare Part D, more than half of the beneficiaries were liable for paying the entire out-of-pocket cost of their generic prescription drug, according to an analysis from Avalere. Avalere...

Part D Out-of-Pocket Costs Pose a Barrier to Treatment Access

by Victoria Bailey

Out-of-pocket costs may dissuade Medicare beneficiaries from initiating treatment with high-price Part D specialty drugs, as beneficiaries without low-income subsidies were less likely to fill a new...

BCBSA Partnership Aims to Increase Access to Low-Cost Insulin

by Victoria Bailey

The Blue Cross Blue Shield Association (BCBSA) has partnered with a nonprofit generic drug company to help increase access to low-cost insulin for members living with diabetes. Along with several...

Payers, Orgs React to Coverage Implications of Build Back Better

by Kelsey Waddill

Updated 11/22/21: This article has been updated to include a statement from AHIP. Payers and stakeholder organizations have had mixed reactions to the Build Back Better Act, which passed in the...

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