AHIP Marketing Campaign Targets Pharma’s Prescription Drug Pricing
AHIP has launched a marketing campaign targeting pharmaceutical companies and the role of prescription drug pricing in healthcare spending. “Let’s be clear, Big Pharma continues to...Adjusting Medicare Drug Price Negotiation Criteria May Increase Savings
Adjusting eligibility criteria for Medicare prescription drug price negotiation under the Inflation Reduction Act to include drugs with biosimilars and allow for drug selection based on net spending...58% of Payers Use Outcomes-Based Contracts for Prescription Drugs
More than half of payers used an outcomes-based contract in 2022, with most preferring contracts with both claims-based and clinical outcomes, an Avalere survey found. The online survey was conducted...AHIP Argues In Favor of the Copay Coupon Accumulator Rule
AHIP submitted an amicus brief in favor of the HHS copay coupon accumulator rule, which would allow states to decide whether pharmaceutical manufacturers’ copay coupons should contribute to...Feds Share Details on Inflation Rebates for Medicare Prescription Drugs
The Department of Health and Human Services (HHS) and CMS have lowered prices for over two dozen Medicare prescription drugs including biologics for a set timeframe. Starting on April 1, 2023,...Top Threats, Priorities in Employer-Sponsored Health Plan Benefits
Employers shared the main threats and priorities that they encounter as they try to manage employer-sponsored health plan benefits, according to a survey from the Midwest Business Group on Health...How the Inflation Reduction Act Impacted Medicare Part D Benefit Design
Medicare Part D plan liability could lead to major changes in benefits and formulary design for beneficiaries in the coming years, according to an Avalere study that was funded by PhRMA. The...Why Employers Prefer Employer-Sponsored Health Plans Over Exchanges
Large employers find that employer-sponsored health plans allow them to maintain control over employee health plan choice and healthcare spending in order to streamline coverage for their workforces,...HHS Introduces Models for Lowering Prescription Drug Spending
The Department of Health and Human Services (HHS) has released three models intended to bring down prescription drug spending for consumers in Medicare and Medicaid. “These selected models will...Centene Managed Care Plans Will Pay Medi-Cal $215M for Overcharges
Centene must pay Medi-Cal, California’s state Medicaid program, over $215 million to settle allegations that it two of its managed care plans overcharged the program by reporting inaccurate...BCBSA: 6 Policy Changes Could Save $767B in Healthcare Spending
In a report and briefing, Blue Cross Blue Shield Association (BCBSA) recommended policy solutions that could help bring runaway healthcare spending under control, saving $767 billion across 10...BCBS Health Plan Expands Medicare Advantage Drug, Mental Health Benefits
Blue Cross Blue Shield of Massachusetts (Blue Cross) introduced prescription drug benefits and mental healthcare benefits to its preferred provider organization (PPO) and health maintenance...Out-of-Pocket Healthcare Spending for Generics Rose from 2011-2019
While negotiated drug prices dropped, out-of-pocket healthcare spending on generic prescription drugs increased for patients as generics moved from Tier 1 to tiers typically dedicated to brand drugs,...40% of Americans Blame Deductibles for High Out-of-Pocket Healthcare Costs
Member experience in the US healthcare system is fraught with challenges, but there are steps that policymakers can take to reduce out-of-pocket healthcare costs and make navigation more amenable,...Most of Premium Dollar Used for Prescription Drugs, Medical Services
Almost 83 cents of the average healthcare premium dollar goes towards prescription drugs and medical services, including inpatient and outpatient costs, emergency room costs, and doctor visits,...Payers Praise Inflation Reduction Act, Warn About Pharmaceutical Loopholes
When the Senate passed the Inflation Reduction Act on August 4, 2022, payers and payer organizations met the proposed law with largely positive reactions, though some payer groups pointed out areas...How Family Income Impacts Out-of-Pocket, Catastrophic Spending on Insulin
Family income is a significant factor in the levels of out-of-pocket and catastrophic spending on insulin among insulin users, a study published in Health Affairs found. The researchers leveraged 2017...UnitedHealthcare Cuts Out-of-Pocket Healthcare Costs for Insulin
UnitedHealthcare has announced that it will eliminate out-of-pocket healthcare costs for insulin and other emergency use drugs for fully insured group health plan members. Members will be able to...63% of Medicare Beneficiaries Paid Full Generic Drugs Cost in 2020
Under Medicare Part D, more than half of the beneficiaries were liable for paying the entire out-of-pocket cost of their generic prescription drug, according to an analysis from Avalere. Avalere...Sponsored Article
