Apr 12, 2019 | Managed Care Friday
1. 16,752. No, this isn’t another Rent song, it’s the average cost believe it or not that a diabetic person will spend on average each year on medical costs, according to a recent study by the ADA. Cigna and Express Scripts introduced a patient assurance program to cap the out of pocket costs at $25 for every 30-day insulin prescription. Cigna says this reduces the out-of-pocket costs for insulin by 40% or more and improves affordability of insulin costs for people with diabetes. The Patient Assurance Program will be available to members in participating non-government funded pharmacy plans...
Apr 11, 2019 | Drugs, Pharmacy
The US spends more on prescription drugs each year than any other country. BRG Experts Bryan Cote, Aaron Vandervelde, and Eleanor Blalock assisted with both primary and secondary research used in a recent PEW study, which offers new perspectives on how the pharmaceutical supply and payment chain for retail drugs evolved from 2012-2016. Click to read more.
Apr 10, 2019 | Payer Services, Payers
Copay accumulator programs are increasingly used by insurers and PBMs to exclude the value of manufacturer copay assistance programs from the calculation of a patient’s annual deductible and/or out-of-pocket maximum. Two states recently banned the use of these programs in health insurance plans regulated by the state, and CMS recently proposed to allow Exchange plans to incorporate a limited version of copay accumulators into the benefit design. This brief provides an overview of copay accumulators and recent noteworthy policy developments. Click to read more.
Apr 8, 2019 | Medicare Advantage, Part D, Payers
CMS finalized 2020 rate updates for Medicare Advantage (MA) and other policies for MA and Part D benefit offerings. The final MA rates are expected to increase plan revenue by +2.53%, up from +1.59% in the proposed rates, with an additional +3.3% revenue expected due to plan coding behavior. This brief discusses the rate updates as well as finalized policy changes to MA and the Part D program. Click to read more.
Apr 3, 2019 | Hospice, MedPAC
MedPAC released its annual recommendations to Congress on Medicare rates and other policies. The Congressional advisory agency recommended a -2% update for Medicare payments to hospice in 2020, based on across-the-board positive indicators of current payment adequacy. Congress is unlikely to act on this recommendation in the near term, and even in the long term, Congress is unlikely to pass a negative update to hospice, given widespread support for the benefit. Click to read more.
Mar 29, 2019 | Managed Care Friday
1. 700: Number of direct primary care practices in the US via a new coalition of doctors who provide a kind of low-cost monthly membership to serve people without insurance and those with high deductible plans. The new delivery model has a concierge feel with higher touch care and a new-age pricing model: Memberships are $75 a month for adults, $25 for those under 21, with unlimited telemedicine and office visits and house calls for $25. Labs and meds are charged at wholesale cost plus 10%, according to Jonathan Bushman, who runs Reliant, a practice in Oklahoma that’s part of the emerging...
Mar 28, 2019 | Air, Ambulance
Last year, Congress directed the GAO to write a report on air ambulance services. The report found that in 2017, 69% of commercial claims for air ambulance transports were out-of-network (OON). While the path to passing legislation that addresses issues such as OON and/or balance billing practices will be difficult, this GAO report will be used in the ongoing efforts by lawmakers in Washington. Click to read more.
Mar 27, 2019 | Medicare Advantage, MedPAC, Payers
Medicare Advantage enrollment continues to grow, in absolute numbers and as a percentage of Medicare beneficiaries, and is also becoming more concentrated in a few top MA organizations. MedPAC explores this growth, as well as notes issues with CMS’s quality measures for the star ratings program and the widening gap between MA costs to provide care and fee-for-service Medicare spending in the same geography. Click to read more.
