From AIS's Health Reform Week - A widely used industry benchmark for pricing pharmaceuticals is forecast to grow dramatically in the coming years, according to some pharmacy benefit insiders who claim the 2010 Affordable Care Act’s (ACA’s) fee on brand drugmakers is a key reason behind the increases. The average wholesale price (AWP) benchmark for some high-cost “specialty” drugs already has grown at a 20% annual rate in recent years, says one industry expert. And others say the AWP growth rate is set to triple that of historic levels. Read more
From Health Plan Week - The “final frontier” of untapped membership is how one industry insider describes the dual-eligibles market. And now is the time many health insurers are seeking to win a slice of the richly reimbursed niche. With more than 9 million duals in the country, a series of reform law-funded demonstration programs for those eligible for both Medicare and Medicaid benefits have started or will soon. Read more
From ACO Business News - North Carolina Gov. Pat McCrory (R) hopes to use a combination of existing accountable care organizations and new ACOs to serve most of the state’s Medicaid population in a plan he estimates could save $1 billion over five years, in part by requiring the ACOs involved to accept downside risk. The program, which was unveiled in late February and still needs approval from state lawmakers, replaces McCrory’s original plan to implement… Read more
From Medicare Advantage News - The Medicare Advantage Special Needs Plan (SNP) industry won another one-year extension — this time through the end of 2016 — in the “doc fix” legislation passed by the Senate March 31 after earlier being passed by the House. But the law — H.R. 4302 — did not include the more permanent extensions and payment-relief provisions that had been in the Senate Finance Committee markup and latest Senate version of… Read more
From Drug Benefit News - A new report from a coalition of stakeholders suggests that a considerable portion of hospitals enrolled in the 340B Drug Pricing Program provides a negligible amount of free or reduced-price care to indigent, uninsured patients. This report, which was partly funded by PBMs, adds to the growing body of analysis questioning whether hospitals that qualify for special drug pricing under the federal program are actually using the savings for their… Read more
From Report on Medicare Compliance - Although they are frustrated with the one-year delay in ICD-10 implementation, hospitals are not necessarily abandoning their preparation for the switch to the new coding system. “We are telling members to stay the course,” Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA), tells RMC. The Protecting Access to Medicare Act of 2014 (RMC 3/31/14, p. 1), which was signed by President Obama on April 1, says CMS… Read more
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