Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Prescription drug spending

91% of Physicians Say Prior Authorizations Negatively Impact Care

February 7, 2019 - Prior authorizations (PAs) are causing significant delays in care and adding unsustainably to the administrative burdens of physicians, according to a new survey published by the American Medical Association (AMA). The majority of physicians stated that prior authorizations negatively impact the care process by extending waiting periods for treatment and increasing treatment...


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HHS Proposes Eliminating Drug Rebates to Cut Prescription Costs

by Jennifer Bresnick

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...

UPMC, AstraZeneca Enter Value-Based Pharmaceutical Contract

by Jennifer Bresnick

UPMC Health Plan and AstraZeneca are taking on the challenge of a value-based pharmaceutical contract for one of the manufacturer’s cardiovascular medications. Reimbursement for prescriptions of BRILINTA, a drug intended to help...

Walgreens Agrees to $296M Settlement in Healthcare Fraud Cases

by Jessica Kent

Walgreens has agreed to pay a total of $296.2 million in settlements for two separate healthcare fraud cases. The first settlement, approved on January 16, 2019, requires the pharmacy chain to pay $209.2 million to resolve allegations...

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...

CMS Tackles Drug Costs with New Medicare Advantage, Part D Models

by Jessica Kent

CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices and better serve...

Walmart, CVS Health Agree on PBM Pharmacy Network Rates

by Jennifer Bresnick

Walmart and CVS Health have signed a multi-year agreement to keep Walmart participating in the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid pharmacy networks. Walmart will continue to offer services to...

CA Governor Addresses Prescription Drug Costs, Healthcare Access

by Jessica Kent

California Governor Gavin Newsom has announced a series of major executive actions and budget proposals to reduce prescription drug costs and move California closer to the goal of healthcare coverage for all. Newsom’s healthcare...

Steward Health Care Joins Mission to Expand Generic Drug Access

by Jessica Kent

Steward Health Care has become a founding member of Civica Rx, a collaborative, non-profit drug company with the mission to reduce drug costs and increase the supply of life-saving generic medicines. Approximately 800 US hospitals have...

Cigna Announces Closing of $67B Purchase of Express Scripts

by Jennifer Bresnick

Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

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,...

Employers to Address Healthcare Consumerism, Innovation in 2019

by Kyle Murphy, PhD

The National Business Group on Health has released its top-five trends for the coming year, and employers clearly want to play a more involved role in healthcare transformation. Chief among their expectations over the next twelve months...

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...

CMS Reports Slowed Growth of National Health Spending in 2017

by Chuck Green

Last year, healthcare spending in the US jumped at an estimated rate of 3.9 percent to $3.5 trillion – or $10,739 per person, according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicare...

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)...

Employers Working to Drive Down Rising Health Insurance Costs

by Kyle Murphy, PhD

The realization that consumers using less care but paying more to receive services and treatment is leading employers to rethink their approaches to providing health coverage to their employees, according to a recent report in The Wall...

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

by Kyle Murphy, PhD

CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

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...

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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