Pharminent

Op-Ed: Why single-payer health-care could be closer than you think

How chaos surrounding the GOP’s health-care plan could bring the U.S. closer to single-payer, says Proteus Duxbury. http://www.cnbc.com/2017/06/26/single-payer-health-care-is-closer-than-you-think-commentary.html

Filed under: Payer

CVS Point-Of-Sale Rebate Program Adopted By ‘Several’ Payers

Manufacturer rebates can be used to reduce patient cost sharing at point of sale under the PBM’s program. https://pink.pharmamedtechbi.com/articles/2017/06/15/cvs-pointofsale-rebate-program-adopted-by-several-payers

Filed under: Payer

CMS Press Releases Take on a More Political Tone

(MedPage Today) — Releases mentioning the ACA emphasize negatives https://www.medpagetoday.com/publichealthpolicy/healthpolicy/65351

Filed under: Payer

CMS Rule on ACA Marketplaces Helps Insurers

(MedPage Today) — Should help consumers indirectly, say experts https://www.medpagetoday.com/publichealthpolicy/healthpolicy/64605

Filed under: Payer

CMS Will Give Labs More Time to Report PAMA-Required Payor Data

https://www.genomeweb.com/reimbursement/cms-will-give-labs-more-time-report-pama-required-payor-data

Filed under: Payer

Payers Weigh the Implications of Multigene Testing Coverage in New UCSF Study

FORT WASHINGTON, Pa., Feb. 15, 2017 /PRNewswire-USNewswire/ — Innovation in precision medicine has introduced an amalgam of testing options, of which hereditary cancer panels—multigene tests—are a major component. Additionally, the importance of inherited cancer genomics was further… http://www.prnewswire.com/news-releases/payers-weigh-the-implications-of-multigene-testing-coverage-in-new-ucsf-study-300407868.html

Filed under: Payer

CMS Halts Medicare Part B Drug Payment Demo

(MedPage Today) — Rheumatology, oncology groups cheer http://www.medpagetoday.com/PublicHealthPolicy/Medicare/62130

Filed under: Payer

COA Declares Early Victory in CMS Part B Payment Battle

The change of administrations in Washington, DC may undermine the future of a proposal to revise Medicare Part B drug compensation, a plan that has been widely criticized in the oncological community because of the potential reduction in profit margins it entails. http://www.onclive.com/web-exclusives/coa-declares-early-victory-in-cms-part-b-payment-battle

Filed under: Payer

CMS Backs up CVS Network Exclusions Under Part D

In its re-interpretation of CMS policy for Medicare Part D drug dispensing, CVS Health has gone against years of allowing in-house physician dispensaries to participate in Medicare Part D.   http://www.onclive.com/publications/oncology-business-news/2016/october-2016/cms-backs-up-cvs-network-exclusions-under-part-d

Filed under: Payer

Express Scripts Adds Diabetes, Inflammatory Drugs to Value Pricing Plan

ArticleThe issue of high drug prices has raised a number of concerns with insurers and employers searching for strategies to provide patients with the most cost-effective payment plans. Staff Author: Ryan BusheyTopics: Legal/Regulatory http://www.dddmag.com/article/2016/09/express-scripts-adds-diabetes-inflammatory-drugs-value-pricing-plan

Filed under: Payer

The co-pay card debate simmers, as payers push back

Will this payer pressure pose an existential threat to co-pay cards even though patients love them? http://www.mmm-online.com/the-co-pay-card-debate-simmers-as-payers-push-back/article/518240/

Filed under: Payer

PBMs push forward toward outcomes-based pricing, despite challenges

The implementation of a broad outcomes-based pricing scheme is a wildly, almost gratuitously complicated project. http://www.mmm-online.com/pbms-push-forward-toward-outcomes-based-pricing-despite-challenges/article/513442/

Filed under: Payer

With new exclusions, payers draw line on pricing

CVS Health’s decision to list Novartis’ biosimilar version of Neupogen also highlighted the growing competitive threat to pricey biologics.  http://www.biopharmadive.com/news/with-new-exclusions-payers-draw-line-on-pricing/423783/

Filed under: Payer

CMS Panel Offers Plan for New Medicare Payment Models

(MedPage Today) — Stakeholders suggest a more interactive process http://www.medpagetoday.com/PublicHealthPolicy/Medicare/57733

Filed under: Payer

D.C. Week: CMS Announces New Model for Primary Care

(MedPage Today) — Advisory committee recommends FDA delay approval for a new EGFR inhibitor http://www.medpagetoday.com/Washington-Watch/Washington-Watch/57391

Filed under: Payer

Viewpoints: Forcing Competition Among Insurers; CMS And The ‘Most’ Attractive ACO Model

A selection of opinions from around the country. http://khn.org/?post_type=daily-breakout&p=614696

Filed under: Payer

Payers Still Denying Coverage Despite Clinical Trial Mandate

A mandate enacted after the 2010 Patient Protection and Affordable
Care Act was supposed to improve health coverage for patients
enrolled in clinical trials; however, nearly 63% of cancer centers
and organizations that responded to a recent survey reported
insurance denials of routine care costs associated with patient involvement
in clinical trials during 2014. http://www.onclive.com/publications/oncology-business-news/2016/April-2016/payers-still-denying-coverage-despite-clinical-trial-mandate

Filed under: Payer

CMS Unveils Bold Approach To Managing Medicare Part B Drug Costs

Proposed payment experiment to include lower ASP reimbursement and value-based purchasing tools, giving CMS Acting Administrator Slavitt plenty to talk about at the PhRMA annual meeting. https://www.pharmamedtechbi.com/Publications/The-Pink-Sheet-Daily/2016/3/8/CMS-Unveils-Bold-Approach-To-Managing-Medicare-Part-B-Drug-Costs

Filed under: Payer

CMS and Health Plans Agree on Quality Measures

Physicians’ societies were involved in identifying the first batch of measures; major health plans will implement them when contracts allow. Medscape Medical News http://www.medscape.com/viewarticle/859037?src=rss

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Clinton’s Close Call In Iowa Keeps Sanders Single Payer Health Plan Alive

Hillary Clinton’s razor thin lead as votes continued to be counted this morning in Iowa’s presidential caucuses keeps alive Bernie Sanders’ single payer health plan idea, a key difference between the two candidates for the Democratic Party’s presidential nomination. http://www.forbes.com/sites/brucejapsen/2016/02/02/clintons-close-call-in-iowa-keeps-sanders-single-payer-health-plan-alive/

Filed under: Payer

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