HIT Consultant

FEBRUARY 22, 2024

What You Should Know: Waltz Health, a digital health company developing smarter, technology-enabled ways to price, distribute and prescribe medications, today announced its entry into the Medicare market. The struggle with out-of-pocket drug expenses affects millions of Medicare beneficiaries annually, particularly underserved groups.

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Health Law Advisor

MARCH 7, 2023

To advance these efforts, CMS established a Medicare Drug Rebate and Negotiations Group dedicated to the IRA and set forth the agency’s intended overarching timeline to implement the various IRA provisions, such as the Medicare Drug Price Negotiation Program and the Part D redesign.

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Jane Sarashon

FEBRUARY 27, 2024

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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Innovaare Compliance

JUNE 27, 2024

The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach to prescription drug coverage. Price Transparency: Increased transparency in drug pricing to enable beneficiaries to make informed decisions.

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Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

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Healthcare Law Blog

JUNE 2, 2023

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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Health Populi

JANUARY 18, 2019

As the Harvard Chan-POLITICO study points out, prescription drug costs are top-of-mind for health consumers in America. As patients continue to morph into consumers who pay for health care services, they are seeking price transparency — but not finding it so easy. And see here on JD Supra for more details on the rules.

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Health Populi

OCTOBER 28, 2019

When asked what factors contribute to rising health care costs in America, most consumers cite the cost of prescription drugs. Taken together, these two data points demonstrate the potent political import of prescription drug prices as the U.S. approaches the 2020 Presidential election.

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Health Care Law Brief

JANUARY 19, 2022

On December 31, 2021, New York Governor Kathy Hochul signed landmark legislation to increase the transparency of prescription drug pricing and to establish requirements on pharmacy middlemen. Medicare and Medicaid have had similar price transparency rules, but now those rules will apply across all lines of business in New York.

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Prescription Drug Pricing Licensing Compliance Medicaid 52

Jane Sarashon

JULY 18, 2024

One-third were specifically worried about paying for prescription drugs in the next 12 months, an increase from 25% in 2022. Millions of seniors (8 million, the report quantifies) in Medicare were also part of this large contingent of health citizens concerned about their ability to access medicines.

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Health Populi

OCTOBER 24, 2022

health care system not seen since the 1968 creation of Medicare, coupled with decreased reimbursement due to health care reform. The XY supply demand curve shown above from Trilliant’s analysis illustrates a government price ceiling shock to health care pricing.

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Health Populi

OCTOBER 8, 2019

Pricing failure, the second big waste factor, is predominantly challenged by pharmaceutical/prescription drug pricing based on this research. The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027.

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HIT Consultant

JANUARY 21, 2022

An AARP report finds in 2020 that the price of hundreds of brand-name medications rose more than twice as fast as inflation. Part of Biden’s Build Back Better plan would enforce an annual out-of-pocket cap on what people on Medicare pay for their prescription drugs. Partnership Details.

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Health Populi

APRIL 30, 2021

As such, the debate on prescription drug pricing in the U.S. is heating up, with President Biden mentioning the scenario of Medicare negotiating drug prices with pharmaceutical manufacturers in his latest speech measuring progress at 100 days in the White House.

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Hall Render

FEBRUARY 25, 2022

The 55 hospitals penalized by Medicare 8 years straight over patient complications. Medicare penalizes 40 hospitals in Florida for patient safety. Whitmer signs bills designed to lower prescription drug prices in Michigan. Ohio ASC, health system to pay $3M to settle improper Medicare claims allegations.

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Hall Render

FEBRUARY 18, 2022

13-year Medicare payment dispute will return to HHS, court rules. A layoff list, expired medicine, neglected patients: Illinois hospital loses Medicare contract. Bill on prescription drug pricing inspires support from Maine residents, opposition from pharmaceutical industry. 64M VA health clinic opens in Portland.

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Hall Render

MAY 10, 2024

Health Policy Commission still missing key document in Steward sale to Optum Local obesity drug developer lands deal worth up to $600M with Novo Nordisk Mass. Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

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Hall Render

JULY 22, 2022

CMS releases Medicare OPPS and ASC proposed rule. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. Rising prescription drug prices contributed to 49% jump in Oregon healthcare costs over 6-year period: report. CMS pitches outpatient payment rule. CMS proposes 2.7% PENNSYLVANIA.

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Health Populi

DECEMBER 30, 2019

Humana’s Bold Goal initiative targeting Medicare Advantage enrollees. Even seemingly popular plan ideas like prescription drug pricing and coverage for pre-existing conditions can’t get traction in Congress or through the White House’s executive pen.

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Health Populi

MAY 8, 2019

In 2018, we saw more incentives to inspire adherence to prescription drug regimens, particularly in Medicare Part D along with increasing focus by pharmacists and providers. For people enrolled in Medicare Part D, 20% faced over $500 in OOP costs. A cost of $125 or more yields abandonment of at least 50%.

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Hall Render

OCTOBER 4, 2024

NATIONAL 5 Stark law issues physicians are closely watching Anti-monopoly advocates urge FTC to block McKesson, Cardinal Health’s big-ticket oncology acquisitions Biden administration doles out $68.5M

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Health Law Advisor

MAY 22, 2023

1339) reflects the overarching legislative push by members from both sides of the aisle and chambers of Congress to address drug pricing issues through federal fixes to the PBM framework. Unlike the IRA, which targeted the Medicare program, the provisions of S. 1339, adding several new amendments to create the version of S.

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Health Populi

OCTOBER 12, 2018

Since the CVS+Aetna announcement last December, the Kaiser Family Foundation ran some numbers on how the merged organization could impact Medicare — a key payor for both health insurance and prescription drugs under Part D. The Academy convened a team with experience and gravitas to inform this report.

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US Department of Health and Human Services Prescription Drug Pricing Health Insurance Medicare 61

Medval Compliance Blog

SEPTEMBER 1, 2021

Recognizing the mounting attention given to hidden fees and surprise billing, on June 24, 2019, former President Trump signed an executive order (EO) directing the Department of Health and Human Services (and additional agencies) to take steps to improve price and quality transparency in healthcare. Medicare Set-Aside Considerations.

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Prescription Drug Pricing Medicare Medicare Hospitals 52

Jane Sarashon

SEPTEMBER 9, 2022

The decline of the pharma industry reputation is an important reality-check here given that even Republican voters have been keen to see greater regulation of prescription drug pricing in recent health tracking polls.

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Health Populi

MARCH 13, 2018

President Trump made clear on the campaign trail and in his interview with TIME magazine as Person of the Year that pharmaceutical companies’ pricing needed to be reined in using government pressure.

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Hall Render

APRIL 12, 2024

New president tapped to lead major hospital system in Denver area New president to lead opening of $650M hospital in Wheat Ridge Telehealth program offers support to forensic nurses Colorado Medicaid program settles lawsuit over lack of mental health care for children Colorado is trying to cut prescription drug prices.

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Health Populi

MAY 14, 2018

This is what happened to pharma stock prices on Friday after President Trump and Secretary of Health and Human Services Alex Azar outlined their new policies focusing on prescription drug prices. ” These prescriptions for lower pharma costs contrast with what most U.S. The graph is the Nasdaq U.S.

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Hall Render

JUNE 23, 2023

NATIONAL AHA, CHA respond to Human Rights Watch report on nonprofit hospitals AMA urges end of noncompete clauses in physician contracts Amazon launches $100M generative AI center, targeting healthcare As urged by AHA, Supreme Court rules government can dismiss FCA case over relator’s objection Biden announces leader of the CDC Bill would give Biden (..)

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Health Populi

FEBRUARY 8, 2023

We capped the cost of insulin at $35 a month for seniors on Medicare. But there are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives. For example, one in ten Americans has diabetes. Not anymore. Let’s finish the job this time.

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Hall Render

NOVEMBER 11, 2022

Physician leaders balk at Medicare 4.48% physician fee cut. Bright Health exiting Florida Medicare Advantage market. in prescription drug pricing case. Duke LifePoint hospital at risk of losing its Medicare contract — again. Wilson hospital again facing federal threat to end Medicare contract.

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Hall Render

FEBRUARY 24, 2023

NATIONAL Addressing Staff Burnout In Healthcare Design Amazon completes $3.9B Staff shortages could spur next public health crisis, Baystate Health CEO warns CommonSpirit, Mass General, Moffitt execs to judge telehealth challenge Brigham and Women’s, AI company get $2.5M grant to improve early cognitive decline detection via EHRs How Mass.

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Health Populi

APRIL 10, 2019

In typical markets, as products mature and get mass adoption, prices fall. But then prescription drug pricing doesn’t conform with how typical markets work in theory. The study analyzed medical claims for millions of patients, both commercially insured and enrolled in Medicare. of family income.

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Health Populi

AUGUST 3, 2018

voters, across the three-party landscape, agree on two healthcare issues this year: coverage of pre-existing conditions, and lowering the consumer-facing costs of prescription drugs. This is the tactic that most Americans say could lower prescription drug prices. There’s growing evidence that a majority of U.S.

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Jane Sarashon

AUGUST 26, 2024

Hear how nurses Jeanne Ayers RN, MPH , Lisa Schavrien RN, BSN and Erin Ainslie Smith MS, BSN, CPST have crafted creative approaches to remove barriers to voting for the benefit of both patients and colleagues in clinical practice.

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Health Populi

APRIL 26, 2019

Health Populi’s Hot Points: The third chart illustrates that pharma pricing is a unifying force across older voters across the three political parties. consumers to import cheaper prescription drugs from other countries. While deep understanding of how U.S.

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Prescription Drug Pricing Governance Medicare Medicare 59

Health Populi

JUNE 18, 2020

The authors, Dr. Naci and Dr. Kesselheim, are affiliated with the London School of Economics and Brigham and Women’s Hospital in Boston, note that 1% of medicines dispensed under Medicare Part D and Medicaid accounted for nearly $1 in $3 of drug spending in each program in 2015. bn to $32.8 bn to $9.9 bn for Medicaid.

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