- Drugmakers getting bolder in fight over 340B drug discounts (fiercehealthcare.com)
Drugmakers are getting bolder in their bid to restrict access to drugs discounted under the 340B program as legal experts say a lack of enforcement has created a regulatory void...Hospitals are imploring the Department of Health and Human Services to clamp down on several moves by drug companies, including Novartis and AstraZeneca, to limit distribution of certain 340B drugs. But experts say an administration-wide change in what agencies can enforce is likely behind drugmakers’ aggressive moves...“It is an outrage that these actions are being taken at a time when hospitals are in the midst of their response to the COVID-19 public health emergency, which has further demonstrated the fractured, inadequate state of the prescription drug supply chain,” the American Hospital Association said in a release last week..It is the most aggressive move in a fight sparked last month between drug companies against contract pharmacies, which are a popular tool among 340B hospitals...READ MORE
- Some providers face daunting repayment deadline for Medicare advance loans (fiercehealthcare.com)
Hospital groups are imploring either the Centers for Medicare & Medicaid Services or Congress to step in and help providers facing loan repayments happening as soon as Aug. 1...The...deadline has sparked concerns from some experts and hospital groups that worry providers couldn’t afford to lose out on Medicare revenue as they combat revenue losses caused by the pandemic. While the program was intended to be a short-term solution, COVID-19 surges are proving that is not the case for some hospitals...At the onset of the pandemic in March, the Centers for Medicare & Medicaid Services extended the advance payment program, which has been used previously to help providers beset by disasters...CMS had given out $100 billion of loans before suspending the program...The goal behind the program is to help providers stay afloat and was meant to be a short-term solution, as repayment starts 120 days after a provider gets the first payment...READ MORE
- Insurers worry drug companies could game changes to Medicaid rebate program in new rule (fiercehealthcare.com)
Insurers are worried a raft of proposed changes to the Medicaid Drug Rebate Program could lead to drug manufacturers gaming the system to charge higher prices...Several insurer groups commented on the proposed rule that the Centers for Medicare & Medicaid Services released last month to get states and drugmakers to create more value-based payment arrangements...If finalized, the rule would relax some of the requirements for the average manufacturer price and best price that manufacturers must provide for Medicaid. Under the new rule, a manufacturer could report multiple best prices for a therapy under the Medicaid Drug Rebate Program, but any best price has to be tied to a value-based purchasing agreement...READ MORE
- CMS Lowers Medicare Insulin Copays (drugtopics.com)Out-of-Pocket Insulin Costs Remain Stable for the Privately Insured (ajmc.com)
The Centers for Medicare & Medicaid Services is reducing insulin copays for seniors who are eligible for Medicare via an executive order from President Donald Trump...Participating enhanced Medicare Part D plans in 2021 will provide a broad set of insulins at a maximum $35 copay for a month’s supply of each type of insulin, the White House said in a fact sheet on the new initiative...CMS estimates that beneficiaries could save $446, or 66%, a year for their insulins, the agency said in a press release...READ MORE
- CMS to require hospitals to report critical COVID-19 data on bed capacity, PPE and cases (fiercehealthcare.com)
The Trump administration is now going to require all hospitals to submit daily critical information on COVID-19, including bed capacity and the availability of essential supplies...The Centers for Medicare & Medicare Services released an emergency regulation...calling for the mandatory reporting. The agency also posted new requirements for lab reporting and revised a policy for physician and pharmacist orders for COVID-19 tests...“While many hospitals are voluntarily reporting this information now, not all are,” CMS said in a release. “The new rules make reporting a requirement of participation in the Medicare & Medicaid programs.”...READ MORE
- Pharmacy groups tell HHS that any action on rebate rule must involve fixing pharmacy DIR fees (chaindrugreview.com)
The country’s leading pharmacy groups said that any action on a prescription drug rebate rule must address skyrocketing fees extracted by pharmacy benefit managers on behalf of plan sponsors in Medicare Part D...“We remind the Administration of the continuous and heightened impact of pharmacy DIR fees imposed by Medicare Part D plan sponsors and their pharmacy benefit managers (PBMs) on our members. Pharmacy DIR fees are growing beyond CMS’ projection of 10% year-over-year...“If pharmacy DIR fees are not addressed in a forthcoming rebate rule, the impact on our members and their ability to care for patients in such a system will prove detrimental...READ MORE
- Pharmacy Groups Urge CMS to Reimburse for Medical at Home Services (drugtopics.com)
A group of pharmacies and pharmacy organizations urged the Centers for Medicare & Medicaid Services to formally recognize and promote medical at home pharmacy services for long-term care —particularly in the wake of the coronavirus disease 2019 (COVID-19) pandemic...“With medical at home pharmacy services being needed now more than ever due to the coronavirus public health emergency, long-term care pharmacy stakeholders are urging the Centers for Medicare & Medicaid Services to formally recognize and promote these services to help improve value-based patient care, increase savings, and ensure pharmacy providers are fairly and properly reimbursed,”...READ MORE
- Drug payment cuts to 340B hospitals spur debate on best path forward (healthcarefinancenews.com)
Hospitals say revenue from the 340B program is essential, while others contend the original law is being abused...an federal appeals court ruled that 340B hospitals will now be subject to Medicare cuts in outpatient drug payments by nearly 30%... gives...the Department of Health and Human Services the legal authority to reduce payment for Medicare Part B drugs to 340B hospitals...the action means patients – particularly those who live in vulnerable areas – will pay less out-of-pocket for drugs in the Medicare Part B program...providers...said the 340B decision will hurt hospitals and patients in these vulnerable areas...Hospitals that serve large numbers of Medicaid, Medicare and uninsured patients were getting the drugs for a discounted price, but, getting reimbursed at the higher price...The hospitals...are in the red or operating on thin margins, were using the pay gap in the price difference to cover operational expenses. HHS deemed it inappropriate that these facilities would use Medicare to subsidize other activities and initiatives...READ MORE
- AHA, AAMC press appeals court for rehearing on site-neutral payments case (fiercehealthcare.com)
The American Hospital Association and Association of American Medical Colleges announced...they are seeking a rehearing on the ruling earlier this month from the U.S. Court of Appeals for the District of Columbia. The ruling upheld the Department of Health and Human Services’ authority to install Medicare payment cuts to off-campus hospital clinics to bring them to the same payment level as physician offices...“These illegal cuts directly undercut the clear intent of Congress to protect hospital outpatient deaprtments because of the many real and crucial differences between them and other sites of care,” the AHA and AAMC said in a statement...READ MORE
- Pfizer sues to cut Vyndaqel copays, calling Medicare ban unconstitutional (fiercepharma.com)
Pfizer’s rare heart disease med Vyndaqel, at $225,000 a year, is too pricey for many patients. To help Medicare participants afford the expensive drug—and maintain its hefty sticker price—the Big Pharma is going as far as to argue the U.S. government’s anti-kickback policy is unconstitutional...Pfizer questions two federal regulations that prohibit drugmakers from offering direct payments to help cover a drug’s cost or working with charity programs to direct their funding—and Medicare patients—to a particular medicine...If Pfizer's argument succeeds, essentially, it would open up federal insurance programs to the sort of copay assistance drugmakers often offer to privately insured patients, particularly for pricey medications and new launches...READ MORE