Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Prescription Drug Rates

Trump Administration Touts IPI Model for Reining In Drug Prices

December 7, 2018 - 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 about government price fixing should be among the most vocal opponents of the status quo,” HHS Senior Advisor for Drug Pricing Reform John...


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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...

Generic Drugs Could Have Saved $3B for Medicare Part D Program

by Thomas Beaton

Using generic drugs instead of their brand-name equivalents could have saved the Medicare Part D program approximately $3 billion in 2016 alone, according to new data from HHS. A relatively small number of brand-name therapies is...

BCBSA Adds Opioid Abuse Accreditation to Treatment Facilities

by Thomas Beaton

The BlueCross BlueShield Association has announced a new accreditation program for opioid abuse treatment centers as a larger part of the organization’s mission to combat the US opioid crisis. In 2013, only 22 percent of treatment...

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare

by Thomas Beaton

CMS has proposed a series of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As...

CMS Approves Okla. Value-Based Drug Purchasing for Medicaid

by Thomas Beaton

CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on treatment outcomes. CMS allows state...

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