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Monthly Round-Up of What to Read on Pharma Law and Policy

Bill of Health

New Reforms to Prescription Drug Pricing in the US: Opportunities and Challenges. Reforming Patient Cost Sharing for Cancer Medications in Medicare Part D. JAMA Oncol. 2022 Aug 4. Epub ahead of print. Hwang TJ, Kesselheim AS, Rome BN. 2022 Aug 19. Epub ahead of print. Lumpkin MM, Hamburg MA, Schultz WB, Sharfstein JM.

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Vendor Notebook: new tools and acquisitions from OptumRx, ScionHealth, others

Healthcare IT News - Telehealth

OptumRx launched Price Edge, a tool that compares pricing for traditional generic drugs to ensure members get the lowest prescription drug prices. It's a new year, and healthcare technology vendors are rolling out their latest innovations, market approvals, acquisitions and staffing shake-ups.

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A Health Consumer Bill of Rights: Assuring Affordability, Access, Autonomy, and Equity

Jane Sarashon

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

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Supreme Court Clarifies that Subjective (Not Objective) Knowledge of Falsity of Claim Dictates False Claims Act Liability

Healthcare Law Blog

In the underlying Seventh Circuit cases, relators alleged that retail pharmacies had knowingly submitted false reports of their Usual and Customary (“U&C”) drug prices to the government for reimbursement under Medicare Part D and Medicaid, because the reports allegedly did not account for discounted drug prices offered through certain prescription (..)

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Magnolia Regional used price transparency IT to get more CHF patients to fill their prescriptions

Healthcare It News

"With prescription drug prices rising at every turn, patients need price transparency and the ability to discuss options with their doctors during office visits," Davis advised. ADVICE FOR OTHERS.

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Comments to CMS Guidance on the Medicare Prescription Drug Inflation Rebate Program Due March 11, 2023

Health Law Advisor

However, CMS’s release of the Initial Rebate Guidances represents the agency’s first significant opportunity to submit substantive and specific input from the broader stakeholder community with regard to one of the most significant components of the prescription drug pricing changes of the IRA.

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Medicare Prescription Payment Plan (M3P) Implementation: Key Considerations for Part D Plan Sponsors and PBMs

Innovaare Compliance

How M3P Payments are Calculated Under M3P, payments are calculated using a formula defined by the Centers for Medicare and Medicaid Services (CMS). These requirements include: Detailed Reporting: Plans must submit comprehensive data on prescription drug pricing, utilization, and patient outcomes.