On January 31, 2019, HHS proposed sweeping changes to the current system for medication pricing and contracting by PBM companies in federal programs. This summary reviews OIG's proposal to eliminate the safe harbor protections for rebates that exist in the federal Anti-Kickback Statute (AKS) and replace these protections with proposed new safe harbors allowing for point-of-sale discounts to beneficiaries and for manufacturer-paid service fees to PBMs.
On January 30, 2019, the Centers for Medicare and Medicaid Services (CMS) published an Advanced Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter, known as the “ draft Call Letter.” The draft Call Letter outlines payment amounts for beneficiary cost sharing, risk corridors for Part C and Part D plans, and beneficiary payments for calendar year 2020.
HIV positive patients on single tablet regimens have better adherence and lower inpatient health costs, according to a retrospective claims data analysis published in JMCP.
Findings from this review indicate that health care providers approach biosimilars with caution due to limited knowledge, low prescribing comfort, and concerns over safety and efficacy. The authors of this JMCP article recommend clinician-directed education to realize the full cost-saving potential of biosimilars.
On January 30, 2019, CMS issued its draft Part D Payment Policies and 2020 Draft Call Letter.
The draft Call Letter outlines payment amounts for beneficiary cost sharing, risk corridors for Part C and Part D plans, and beneficiary payments for calendar year 2020. Many of the draft provisions for the 2020 plan year revolve around opioids and CMS’s effort to ensure beneficiaries are receiving appropriate pain management therapy. CMS also proposes numerous updates, changes and potential new measure concepts for the Star Ratings Program. CMS is also considering changing policies and is accepting comments relating to its tier composition policy for generics and specialty medications in Part D.
The Academy of Managed Care Pharmacy (AMCP) appreciates the opportunity to provide comments to the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) in response to the draft Strategy on Reducing Burden Relating to the Use of Health IT and EHRs.
On February 28, 2019, AMCP provided comments to the CMS and ONC in response to the draft Strategy on Reducing Burden Relating to the Use of Health IT and EHRs.