Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Prescription Drug Rates

Private Payers Deny Hepatitis C Drug Coverage to 52% of Members

June 13, 2018 - Private payers denied Hepatitis C drug coverage to 52.4 percent of commercially insured beneficiaries from 2014 to 2017, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Hepatitis C drug access for public payer beneficiaries was also heavily restricted during the same three-year period. About 35 percent of Medicaid beneficiaries and 15 percent...


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MN Law Allows Some Patients to Override Payers on Step Therapy

by Thomas Beaton

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to bypass...

CMS: Medicare Part D Gag Clauses are “Unacceptable”

by Thomas Beaton

CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug price transparency for beneficiaries. “We...

CMS Highlights Drug Price Transparency Data Dashboards

by Thomas Beaton

CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore data...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

by Thomas Beaton

Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including some...

CVS Health Offers New Tools for Lowering Prescription Drug Costs

by Thomas Beaton

CVS Health has launched new cost-saving initiatives that aim to lower beneficiary prescription drug costs through co-pay adjustments, pricing transparency technology, and increased promotion of generic drugs. The initiatives follow a CVS Health...

BCBS Association: Use Alternative Pain Therapies Before Opioids

by Thomas Beaton

The BlueCross BlueShield Association (BCBSA) has announced a new professional standard that removes opioid prescriptions as a primary pain treatment in a majority of clinical situations. The payer’s National Council of Physician and Pharmacist...

Aetna Will Apply Pharmacy Rebates to Prescription Drugs in 2019

by Thomas Beaton

Aetna has announced plans to automatically apply pharmacy rebates to eligible prescription drug benefits by 2019 in an effort to increase pricing transparency and control costs. Nearly three million Aetna members are likely to experience lower...

Payers Address Opioid Safety Via Education, $0 Narcan Co-Pays

by Thomas Beaton

Commercial payers are addressing the nation’s opioid crisis and promoting opioid safety by funding patient education programs and waiving Narcan co-pays to reduce barriers to access. Patient-centered strategies have allowed payers like...

96% of Payers Are Committed to Electronic Prior Authorization

by Thomas Beaton

The vast majority of payers are committed to implementing electronic prior authorization solutions as a way to address administrative problems with prior authorization procedures, according to research published through the ePA National Adoption...

AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

by Thomas Beaton

An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to opioids....

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers that overprescribe...

Payers, Providers Pledge to Improve Prior Authorizations

by Thomas Beaton

AHIP, BCBSA, AHA, and other leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden. Leaders of organizations participating in the pledge claim...

Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

by Thomas Beaton

Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017. In...

Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

by Thomas Beaton

Payers may be more willing to provide their beneficiaries with genetic drug therapies that costs hundreds of thousands of dollars if they enter into outcomes-based pharmaceutical contracts that lessen financial risks. An outcomes-based pharmaceutical...

Wellness, Preventive Care to Drive Employer Health Plans in 2018

by Thomas Beaton

Employer-sponsored health plans are expected to widely embrace value-based purchasing agreements and patient engagement technologies that improve employee wellness programs and preventive care, according to the National Business Group on Health...

How Payers Can Streamline Prior Authorization for Prescriptions

by Thomas Beaton

Prior authorization may allow payers to limit unnecessary spending on high-cost prescription drugs, but leading provider experts suggest that payers could do more to boost the efficiency of prior authorization procedures for clinically valid...

Consumers Support Laws to Limit Payer Prescription Switching

by Thomas Beaton

The vast majority of patients living with chronic diseases would support legislation to limit a payer’s ability to switch their prescriptions without medical necessity, according to a new series of surveys.   Ninety-four percent of...

Aetna to Waive Narcan Co-Pays, Combat Opioid Overprescribing

by Thomas Beaton

Aetna will be the first national payer to waive Narcan co-pays for fully-insured members as part of a larger effort to address the nation’s opioid crisis, the payer announced in a press release. Narcan is considered a preferred branded...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

by Thomas Beaton

At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the pharmaceutical...

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