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...Centers for Medicare and Medicaid Services...said it has finalized a decision to cover expensive cancer cell therapies sold by Gilead Sciences Inc and Novartis AG...CMS...said it will cover the U.S. Food and Drug Administration-approved therapies when provided in healthcare facilities that have programs in place to track patient outcomes...The nationwide decision clears up “a lot of confusion” about coverage and will help patients get access to the novel therapies...CMS Administrator Seema Verma said...READ MORE

A year after its opening and a few months after it was targeted in a political debate in the Nevada Legislature, Elite Medical Center...is looking toward 2021...That’s the year that Elite will have to accept Medicare and Medicaid, although CEO Patty Holden, who said it could be much sooner, hopes to work with lawmakers to create different classes of hospitals in Nevada...Less than a mile from Strip landmarks like the Bellagio and Paris Las Vegas, the hospital is working toward accepting Medicare and Medicaid, after state legislators earlier this year passed a law requiring essentially all hospitals in the state to accept the government programs...READ MORE

As rural hospital closures roil the country, some states are banking on a Trump administration proposal to change the way hospital payments are calculated to rescue them...The goal of the proposal, unveiled by Centers for Medicare & Medicaid Services Administrator Seema Verma...is to bump up Medicare’s reimbursements to rural hospitals, some of which receive the lowest rates in the nation...By law, any proposed changes in the calculation of Medicare payments must be budget-neutral; in other words, the federal government can’t spend more money than previously allocated. That would mean any change would have a Robin Hood-like effect: increasing payments to some hospitals and decreasing them to others...READ MORE

NACDS and the National Community Pharmacists Association held a briefing this week for the Congressional Doctors Caucus...chaired by Rep. Phil Roe...comprised of 16 medical providers in Congress who use their medical expertise to develop patient-centered healthcare policy...NACDS and NCPA discussed the Centers for Medicare & Medicaid Services’ recently released proposed rule—Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses—and explained the serious repercussions of direct and indirect remuneration (DIR) fees and the impact they can have on patient access to care and on pharmacies, who are struggling to maintain their businesses amid the uncertainty caused by the retroactive fees. The groups noted that they have advocated strongly for DIR reform in the CMS proposal because it will benefit pharmacies and the patients they serve.

The Trump administration released a final rule...that boosts Medicare payments to rural hospitals in a bid to address major inequalities...The rules included an increase to the wage index for certain low-wage hospitals such as those in rural areas..."The changes we’re finalizing in today’s rule are long overdue and improve the way Medicare pays hospitals, which will help many rural hospitals maintain their healthcare labor force," CMS Administrator Seema Verma...READ MORE

The White House will withdraw a controversial plan to ban drugmaker rebates to pharmacy benefit managers in Medicare and Medicaid, stepping back from what the administration had once billed as "the most significant change in how Americans' drugs are priced at the pharmacy counter."..."Based on careful analysis and thorough consideration, the President has decided to withdraw the rebate rule...noting ongoing discussions about potential legislation around drug pricing...Drugmakers had supported the proposed rule, which fit with pharma's public relations campaign attacking the role played by PBMs in keeping drug costs high...READ MORE

The National Association of Chain Drug Stores RxIMPACT program has launched an Action Alert, urging Congress to provide “DIR fee” relief in time to save pharmacies and to reduce seniors’ out-of-pocket drug costs...pharmacy advocates are contacting U.S. Senators and members of the U.S. House of Representatives to build support for the Phair Pricing Act (H.R. 1034/S. 640). The bill would do what a recent Medicare rule left undone: providing relief from abusive pharmacy direct and indirect remuneration fees. The goal is to assure this is part of a drug-pricing bill that is enacted soon...“If our government is serious about stopping this unacceptable treatment of pharmacies, about reducing patients’ drug costs at the pharmacy counter, and about reducing overall healthcare costs, then they need to close this loophole and end the abuses of pharmacy DIR fees now,” said NACDS president and chief executive officer Steven Anderson...READ MORE

The Trump administration is proposing a rule that would require hospitals to publish the prices that are negotiated with insurers or risk being fined...The proposed rule...would apply to the roughly 6,000 hospitals that accept Medicare. Hospitals could be fined up to $300 a day if the standard and negotiated prices for services are not posted online...Starting this year, the administration required hospitals to publish list prices, or the sticker price. That does not reflect what someone might pay with insurance. The proposed rule would go a step further and require hospitals to also post the prices various insurance plans pay...“We’re trying to change the paradigm here,” Centers for Medicare & Medicaid Services Administrator Seema Verma said...“We’re trying to ensure we have a competitive free market where providers can compete on cost and quality and patients have the information they need to seek high-quality providers.”...READ MORE

The Centers for Medicare & Medicaid Services approved a request...from Washington state to negotiate value-based drug rebate agreements with pharmaceutical manufacturers in its Medicaid program...The approval makes Washington the fourth state to test such an arrangement; similar policies have already been given the OK in Oklahoma, Michigan and Colorado, according to an announcement from CMS...Washington officials are aiming to test a “subscription” model for hepatitis C drugs...In this model, Medicaid would pay a fixed annual sum to a drug company for the hepatitis C medication, purchasing an unrestricted supply of the drug... CMS is committed to increasing states’ flexibility to develop policies that lower costs, increase the predictability of expenses and improve access for patients...READ MORE

Elite Medical Center...Since it opened...its business model has been based on providing emergency care to tourists...The federally-run Medicare program for the elderly and the state-run Medicaid program for low-income residents just isn’t lucrative and therefore isn’t part of its business model...The rest of Nevada’s hospitals use their privately insured patients to subsidize the cost of treating those covered under Medicare and Medicaid. Hospitals argue that the rates paid by government insurance programs don’t come close to the actual costs of providing care, so they must carefully balance the number of patients they take under each type of insurance in order to stay financially solvent....the other hospitals believe that Elite is siphoning off the well-insured patients at their expense and without shouldering any of the burden for treating those on Medicare or Medicaid. That’s why the state hospital association is pushing for lawmakers to pass AB232, which would require essentially all Nevada hospitals to accept Medicare and Medicaid...READ MORE