Medicare

Newly tapped Senate Finance Chair Chuck Grassley (R-IA) said Wednesday (Jan. 9) he opposes Medicare drug price negotiation, but he seemed to imply he’s open to either changing or eliminating the risk corridors that help protect Part D drug plans from losing money.

CMS Administrator Seema Verma said Thursday (Jan. 10) that an updated 2018 requirement that hospitals post price information online in a machine-readable format is just a ‘first step’ to helping patients understand health costs, and that hospitals themselves can go further with price transparency.

CMS says in recently released guidance that states do not need to obtain a Medicare denial for certain durable medical equipment coverage before Medicaid, which acts as a secondary payer for those dually eligible for Medicare and Medicaid, can pay for the equipment.

HHS recently told stakeholders it will prioritize models out of the Physician-Focused Payment Model Technical Advisory Committee that reduce mortality or are expected to reduce spending by at least $10 billion annually once expanded nationally, and the department has pegged six model areas for close consideration.

Cancer doctors were already working on a performance-based pay system with drug makers when HHS proposed indexing Part B drug prices to those in foreign countries, and the proposed International Pricing Index model lit a fire under those negotiations.

Newly-elected House Speaker Nancy Pelosi (D-CA) has paved the way for hearings on Medicare for All early in the upcoming Congress, ushering in the Democratic Congress by appealing to the more left-leaning, progressive members of her caucus.

The Trump administration is expected to keep drug pricing on center stage in 2019 following a flurry of action last year. In 2018, the administration released a 44-page blueprint with ideas and questions on potential ways to lower drug prices and reduce out-of-pocket costs, and HHS, FDA and CMS proposed a torrent of regulations and notices.

It’s going to be more difficult for brand drug makers to get Congress to lower their share of seniors’ Part D donut-hole costs now that Democrats control the House, and the industry also exposed itself to billions of dollars in offsets while trying to roll back the donut hole policy in 2018, which Congress could use in 2019 to fund other health sector priorities.

CMS is increasing laboratory fees under the Clinical Laboratory Improvement Amendments by 20 percent, the agency said Friday (Dec. 28). The fee increase is the first in 20 years and is necessary for the program to be sustainable through 2021, CMS said.