Pharminent

Novartis’ CAR-T drug needs new payment model, says Express Scripts

Cost of Novartis’ revolutionary therapy is obstacle, says CMO.
The post Novartis’ CAR-T drug needs new payment model, says Express Scripts appeared first on Pharmaphorum. https://pharmaphorum.com/news/novartis-car-t-expensive-us-health-system-express-scripts/

Filed under: Payer

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

Filed under: Payer

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