Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Prescription Drug Rates

HHS Proposes Eliminating Drug Rebates to Cut Prescription Costs

February 4, 2019 - HHS has announced a proposal that would essentially eliminate the existing drug rebate process and instead encourage direct discounts to patients in an effort to control the costs of prescription drugs. The proposal would exclude drug rebates from safe harbor protection under the Anti-Kickback Statute, leaving pharmacy benefit managers (PBMs) and manufacturers open to legal action for...


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Price of Insulin Doubles, Increasing Spending for Members, Payers

by Jennifer Bresnick

Dramatic increases in the price of insulin are driving a rapid uptick in overall spending for diabetes care, according to new data from the Health Care Cost Institute (HCCI). Between 2012 and 2016, the point of sale price for insulin...

CVS Health to Begin Important Work of Integrating Aetna

by Kyle Murphy, PhD

On the eve of Christmas, Judge Richard Leon of the United States District Court for the District of Columbia decided against halting the integration of the two companies in a merger valued at $69 billion. “Based on CVS’s...

Prescription Drug Prices Rise Again After Brief Pause

by Jennifer Bresnick

Several dozen pharmaceutical companies are planning to raise their prices again in 2019 after temporarily holding off on increases as a result of federal pressure. Reuters reports that nearly thirty drug makers, including Novartis, Bayer,...

Trump Administration Touts IPI Model for Reining In Drug Prices

by Chuck Green

On average, Americans pay 80 percent more for the costliest physician-administered drugs than patients in other developed countries, according to a key HHS advisor. “Free market advocates and those who have philosophical concerns...

CVS Unveils New Pricing Tool for Pharmacy Benefit Management

by Chuck Green

CVS Health has introduced a new approach to the pricing of pharmacy benefit management services, the company announced. The Guaranteed Net Cost model simplifies the financial arrangements underlying pharmacy benefit management (PBM)...

Private Medicare Advantage Plans Receive Marketing Boost from DC

by Chuck Green

While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times. With the open enrollment period for the plan...

Insured Consumers Struggling With Prescription Drug Costs

by Kyle Murphy, PhD

Despite having access to health benefits, 40 percent or more of United States citizens have difficulty affording their prescription drugs. A GoodRx survey of 1,060 respondents about their prescriptions between October 29 and November 2...

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

by Chuck Green

The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the...

Cigna: Integrated Pharmacy, Medical Benefits Improve Overall Health

by Thomas Beaton

Integrating pharmacy benefits with medical benefits can help to improve overall health and reduce employer costs, according to a new study released by Cigna. Individuals with connected medical, behavioral and pharmacy health benefits...

New Drug Pricing Model Could Save Medicare Part B $17.2 Billion

by Thomas Beaton

A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.   The International Pricing Index (IPI) will test if using drug price benchmarks other...

PBMs, Specialized Formularies Reduce Managed Care Prescription Costs

by Thomas Beaton

Pharmacy benefit managers (PBMs) with specialized drug formularies can help managed care payers significantly reduce prescription drug costs, according to new research published in the Journal of Managed Care and Speciality Pharmacy. The...

IL Payers File Pharma Lawsuit Over Opioid Prescription Costs, Safety

by Thomas Beaton

A coalition of Illinois payers has sued prominent pharmaceutical companies in a lawsuit that argues the companies are responsible for a spike in opioid prescription costs and patient safety risks. The Intergovernmental Risk Management...

CMS Proposes Drug Price Transparency in Television Ads

by Thomas Beaton

CMS has proposed a new rule that would enhance drug price transparency by requiring drug manufacturers to publish wholesale prices of Medicaid and Medicare prescription drugs during television ads. The proposed rule would require...

Risk Scoring, New Payment Models Can Reduce Medication Non-Adherence

by Thomas Beaton

Adopting new payment models, engaging in targeted risk scoring, and improving prior authorization processes may help payers address medication-non adherence among members with mental health concerns, says a report from the National Council...

Reference Pricing Models for Prescription Drugs May Contain Costs

by Thomas Beaton

Reference pricing models for prescription drugs may help to contain spending and reduce high costs for beneficiaries, says a new report from the Commonwealth Fund. Currently, most payers use tiered drug formularies to manage drug costs,...

AMA Expresses Concern with Medicare Part D Formulary Changes

by Thomas Beaton

New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to HealthPayerIntelligence.com. In an emailed...

CMS Adds Flexibility to Medicare Part D Formulary Strategies

by Thomas Beaton

CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice. A memo from the agency highlights a major upcoming change to the...

OH Medicaid Adopts Pass-Through Model for Managed Care Drugs

by Thomas Beaton

Ohio’s Medicaid program has issued a mandate that requires managed care health plans to re-negotiate pharmacy benefit manager (PBM) contracts to transition from a spread-pricing drug purchasing model to a pass-through model. The...

Medicare Advantage Part B Plans Can Use Drug Step Therapy

by Thomas Beaton

CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered...

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