Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Prescription drug spending

Employers to Address Healthcare Consumerism, Innovation in 2019

December 11, 2018 - 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 in playing a more vocal role in determining the right suite of benefits for their employed population. “The pace of meaningful and sustained...


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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...

AMA: CVS-Aetna Merger Would Reduce PBM Competition, Raise Prices

by Jennifer Bresnick

The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.  The combined entity would drastically reduce competition in many pharmacy benefit management (PBM)...

Medicare Part D Premiums Expected to Decline in 2019

by Thomas Beaton

CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect. Earlier in 2018, CMS issued a final rule that made...

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...

CMS Final Rule Aims to Lower Medicare Prescription Drug Costs

by Thomas Beaton

CMS is planning to lower Medicare prescription drug costs through a final rule that allows members to purchase less expensive biosimilars and generic drugs and increases the potential value of Medicare Advantage (MA) and Part D plans. CMS...

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