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Medicaid

July 16, 2014 | Daily News

A new network of state-regulated compounding pharmacies aims to help compounders that meet a higher bar -- based on accreditation and quality standards -- negotiate with payors and pharmacy benefit managers, which in recent weeks have begun limiting coverage of certain compounded drugs due to the rising costs of the products. The latest move adds to other other recent efforts by compounders to curb the coverage restrictions, which industry, payors and PBMs attribute to billing changes and increased utilization.

July 15, 2014 | Daily News

California expects that six weeks from now it could still have roughly 350,000 pending applications for Medicaid coverage to work through -- a little more than half the number pending at the end of June -- according to its response to CMS' demand that six states submit updated plans by Monday (July 14) for getting through a backlog of Medicaid eligibility determinations and enrollments.

July 15, 2014 | Daily News

The National Coalition on Health Care is spearheading an effort to get drug makers to disclose how much they spend inventing drugs and their rationale for drug prices. The broad-based stakeholder group is trying to set up a meeting with the drug industry and other stakeholders to figure out how the transparency measures would work, but a Pharmaceutical Research and Manufacturers of America official indicated that the drug trade group is not interest in negotiating.

July 14, 2014 | Daily News

The Health Resources and Services Administration revealed Monday (July 14) that it will propose a new interpretive rule on the 340B orphan drug exclusion in the next few days that allows for discounts for non-orphan uses of orphan drugs after a court agreed with the drug industry that HRSA overstepped its authority with a previous orphan drug rule.

Rep. Henry Waxman (D-CA), who was the primary author of the 340B legislation in 1993, said Monday that HRSA's decision is the right one, because the agency's interpretation meets the legislative intent of the law.

July 14, 2014 | Daily News

In the first overhaul of performance criteria that determine accountable care organizations' bonuses, CMS proposed on July 3 to add 12 measures and retire eight of the existing 33 measures.

July 09, 2014 | Daily News

CMS unveiled the second round of health care innovation awards Wednesday (July 9), increasing funding for both rounds of grants to up to $360 million for awards focusing on four areas that include reducing costs for hospital outpatients and testing improvements for certain providers.

July 02, 2014 | Daily News

President Barack Obama's Council of Economic Advisers pointed out that the 24 states that have not expanded Medicaid eligibility under the Affordable Care Act are missing out on billions of dollars in federal funds, economic expansion and better health care outcomes for their residents in a report released Wednesday (July 2).

July 01, 2014 | Daily News

The Government Accountability Office has found that drugs in the Medicare Part D program are more expensive than those purchased under Medicaid, due in part to the latter program's rebates, and in some cases also are more expensive than drugs purchased by the Department of Defense -- a conclusion bolstering key Democrats' view that CMS needs power to negotiate prices.

June 30, 2014 | Daily News

Actuaries should consider the impact of potential breakthrough drugs or devices on spending when establishing the capitation rates for Medicaid managed care plans, health insurance stakeholders tell the trade group representing the nation's actuaries.

June 19, 2014 | Daily News

Democrats on the House Energy & Commerce Committee are using the $1,000-per-pill price of Sovaldi to push for extending Medicaid drug rebates to low-income Medicare beneficiaries.

June 13, 2014 | Daily News

Congressional CHIP advisors on Friday urged Congress to fund the expiring Children's Health Insurance Program for an additional two years, a move viewed as too little by children's health advocates who prefer legislation introduced days earlier by Sen. Jay Rockefeller (D-WV) that would fund the program through 2019.

June 13, 2014 | Daily News

The National Senior Citizens Law Center is asking CMS and the California Department of Health Care Services to suspend passive enrollment in the California demonstration coordinating care for those dually eligible for Medicare and Medicaid after the beneficiary advocates found a series of problems with enrollment and other aspects of the demonstration.

June 10, 2014 | Daily News

Florida will give Medicaid managed care plans a “kick” payment to help cover the higher-than-expected cost of the Hepatitis C drug Sovaldi from May 1 forward, and the state is considering paying plans retroactively to cover some of the costs from the earlier part of the year, according to an investors note from J.P.Morgan.

June 06, 2014 | Daily News

The National Organization for Rare Disorders joins the drug industry in pushing against what it calls insurers' "prohibitive cost sharing structures" as the debate heats up over potential solutions to drug pricing concerns.

June 06, 2014 | Daily News

A report prepared for the Democratic Governors Association suggests policy options for getting Medicaid beneficiaries to take their medicine that include managing medication, coordinating prescription refills, allowing more time between refills and generally teaching people why they should do what their doctor tells them.

June 03, 2014 | Daily News

CMS explicitly reiterated its decision to let state Medicaid programs choose whether to recognize legally married gay couples in guidance released Friday (May 30), a move one official at the Center for Regulatory Effectiveness says shows the agency is doubling down on discrimination against lesbian and gay couples.

June 02, 2014 | Daily News

In what some stakeholders see as a response to congressional pressure, CMS has announced it will not be finalizing the Medicaid Average Manufacturer Price-based Federal Upper Limit reimbursement levels for multiple-source drugs, and a new finalization date will be released alongside expected guidance on how to implement the FULs mandated by the Affordable Care Act.

May 30, 2014 | Daily News

CMS plans to propose this spring a regulation for the second round of the accountable care organization program that the administration touts as one of the most important tests of health care reform, according to the government’s latest regulatory agenda.

May 29, 2014 | Daily News

PhRMA President and CEO John Castellani on Thursday (May 29) gave no indication that drug companies plan to lower prices of specialty drugs, and he reiterated his industry's position that the solution to making drugs affordable is for health plans to lower cost-sharing.

May 28, 2014 | Daily News

A broad coalition touching nearly every health care interest except the drug industry launched a campaign Wednesday (May 28) to combat what it calls an “onslaught of new high-priced prescription drugs” started by the Hepatitis C pill Sovaldi.

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