On June 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released one of their two annual Reports to Congress.[1],[2] The report includes recommendations to revise Medicare Advantage (MA) benchmark policy, streamline the portfolio of alternative payment models (APMs), replace the existing skilled nursing facility value-based purchasing program, revise indirect medical education (IME) payments, and improve [...] Read More
On June 15, 2021, the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released one of their two annual Reports to Congress.[1],[2] The June report addresses high-cost specialty drugs in the Medicaid program; access to mental health services for Medicaid and Children’s Health Insurance Program (CHIP) enrollees; the use of EHR [...] Read More
In late December 2020, the Trump Administration released a final rule designed to promote the use of value-based purchasing (VBP) arrangements between drug manufacturers and payers, including Medicaid. The final rule, released by the Centers for Medicare & Medicaid Services (CMS), also contains policies related to line extensions and copay accumulators. The incoming Biden Administration [...] Read More
The Food and Drug Administration (FDA) has issued a final rule to allow for the importation of certain prescription drugs from Canada. In conjunction with the final rule, the FDA also released guidance for manufacturers that lays out a pathway for manufacturers to import their own drugs. The rule has not yet been published in [...] Read More
CMS’ Office of the Actuary released a report this week on 2018-2027 projections of national health expenditures. Health care spending is expected to rise from 17.9% to 19.4% of gross domestic product (GDP), an annual rise of 5.5 %, in the next decade. CMS states that the key drivers for the rise in expenditures will [...] Read More
In the Bipartisan Budget Act of 2018 the Congressional Budget Office underestimated – by $4 billion – the amount Medicare would save due to changes in Medicare Part D. Instead of saving $7.7 billion, Medicare will actually save $11.8 billion. The savings come from an increase in the government mandated discount that drug manufacturers must offer enrollees [...] Read More
Here are some reimbursement related reasons why access to biosimilars has been slower than hoped, even though patient out-of-pocket costs are lower. Current System Is an Improvement Over Earlier System, But Could Be Better Part B Is For Biologics (and Some Drugs) When I was working at the Senate Legislative Counsel’s office drafting the Average [...] Read More