Healthcare It News

JANUARY 18, 2022

Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. For example, training a predictive model on the general population may be inaccurate when used in a Medicare or Medicaid population.

Pharmaceuticals 348

Pharmaceuticals Accountable Care Accountability Medicaid 348

Bill Of Health

OCTOBER 28, 2022

The selections feature topics ranging from an examination of Park doctrine prosecutions of executives of pharmaceutical and medical device companies, an analysis of patent thickets covering biologic drugs, and a discussion of product hopping strategies among manufacturers of inhalers. The Political Economy of Market Power in Pharmaceuticals.

Pharmaceuticals 96

Pharmaceuticals Regulations Accountability Medicaid 96

Healthcare ECONOMIST

SEPTEMBER 28, 2023

This discount is delivered as a rebate to the PBM from the manufacturer, causing a gross to net difference in pricing for the pharmaceutical manufacturer.” ” The authors note that the PBM market is highly consolidated.

Pharmaceuticals 71

Pharmaceuticals Medicaid 71

Bill Of Health

AUGUST 22, 2022

Concerns for limiting medication access among the Medicaid population are particularly worrisome, as fewer providers are willing to accept Medicaid insurance due to the additional administrative barriers for reimbursement as well as the reduced compensation as compared with private payers.

Medicaid 98

Medicaid Pharmaceuticals Regulations 98

HIT Consultant

AUGUST 5, 2022

Supply costs are often less significant in the cost structure of PPM companies, and campaigns run by large drug companies in an effort to increase market share for pharmaceuticals coming off patent expiration may generate additional opportunities for PPM companies to achieve higher margins on J-Code drug billing.

Life Sciences 98

Life Sciences Telemedicine Healthcare Biotechnology 98

Healthcare It News

DECEMBER 20, 2022

"While I am really hopeful about the momentum we are seeing across healthcare to address health disparities and their underlying causes, there is much work left to do," Sherry told Healthcare IT News in a look ahead at health equity in 2023. " ON THE RECORD.

Quality Improvement 183

Quality Improvement Pharmaceuticals Hospitals Medicaid 183

Healthcare ECONOMIST

DECEMBER 11, 2023

While participation in 340B can be lucrative for hospitals, it also can be administratively burdensome due to extensive record keeping required, the need to insure that Medicaid discounts and 340B discounts do not result in double-discounts, and the potential for differential discounts for in-house compared to contracted pharmacies.

Pharmaceuticals 75

Pharmaceuticals Hospitals Medicaid Hospital IT 75

HIT Consultant

AUGUST 6, 2023

They are no longer simply a place for aging Medicare and Medicaid patients to live out their final years. Both traditional Medicare and Medicare Advantage, along with Medicaid, are leading the way in value-based reimbursement models, according to the report. Nursing homes are evolving. percent of U.S.

Nursing 98

Nursing Medicare Medicaid Pharmaceuticals 98

Healthcare Leadership Council

NOVEMBER 1, 2023

Unfortunately, the federal Centers for Medicare & Medicaid Services (CMS) is proposing a policy change that would assign more “busy work” to key players across the health sector. Under existing rules, the manufacturer would have to offer the highest discount of the three — 30% — to Medicaid.

Medicaid 40

Medicaid Healthcare Pharmaceuticals Medicare 40

Bill Of Health

MAY 22, 2023

Comparison of Research Spending on New Drug Approvals by the National Institutes of Health vs the Pharmaceutical Industry, 2010-2019. Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020. A full posting of abstracts/summaries of these articles may be found on our  website. JAMA Health Forum.

Pharmaceuticals 62

Pharmaceuticals Medicare Regulations Medicaid 62

Healthcare ECONOMIST

APRIL 5, 2022

Novartis Pharmaceutics v Espinoza. However, over time the number of contract pharmacies has increased dramatically and in 2020 some pharmaceutical manufacturers decided to limit the number of contract pharmacies that 340B covered entities could use. If a hospital does not have a pharmacy, contract pharmacies can fill this void.

Pharmaceuticals 58

Pharmaceuticals Medicare Hospitals Public Health services 58

Healthcare ECONOMIST

JANUARY 3, 2022

While most PBRS are used for expensive pharmaceutical products, PBRS also have been used with medical device and diagnostic manufacturers. Device/diagnostic PBRS may differ from those of pharmaceuticals for a number of reasons. Third, devices and diagnostics typically are lower cost than pharmaceuticals.

Pharmaceuticals 72

Pharmaceuticals Medicare Medicaid Hospitals 72

Healthcare ECONOMIST

JANUARY 25, 2022

That the book should be able to so clearly elucidate these issues should not come as a surprise as the authors–Peter Neumann, Joshua Cohen and Daniel Ollendorf–are pre-eminent experts in value-based pricing methodologies for pharmaceuticals. Are high drug prices a good thing? PBMs: The problem or the solution.

Pharmaceuticals 85

Pharmaceuticals Health Technology Medicaid Healthcare 85

NASHP

OCTOBER 20, 2021

The National Academy for State Health Policy’s (NASHP) 2021 annual conference featured a session highlighting Colorado and Maryland’s PDAB laws, as well as New York’s experience with enhanced negotiating authority with manufacturers for high cost drugs within its Medicaid program. Maryland’s Prescription Drug Affordability Board.

Medicaid 116

Medicaid Pharmaceuticals 116

Healthcare ECONOMIST

JUNE 16, 2023

diagnostic testing or a preventive medicine) because the later-stage savings accrue to Medicare or Medicaid. Basic science funding is useful for resolving ongoing ambiguity about AD’s and validating surrogate endpoint as this knowledge is a public good that can be used by private firms to develop specific products. .

Home Care 96

Home Care Pharmaceuticals Nursing Medicaid 96

Home Health Care

MARCH 6, 2023

The Dublin, Ohio-based Cardinal Health is a distributor of pharmaceuticals and a manufacturer and distributor of medical and laboratory products. It’s a truly patient-centric, multi-channel approach that is unmatched in the industry.” The company also provides performance and data solutions for health care facilities. Gregory said.

Home Care 97

Home Care Pharmaceuticals Medicare Patient Experience 97

Healthcare ECONOMIST

APRIL 3, 2024

Medicare , Medicaid) or commercial (e.g., Of note is recent legislation that impacts quality measurement for Medicaid plans. Additionally, the SUPPORT Act man-dated that Medicaid DUR programs monitor the use of antipsychotic medication in children. employer-provided) pharmacy plans. A helpful summary table is below.

Medicaid 69

Medicaid Population Health Prevention Medicare 69

Bill Of Health

MARCH 27, 2024

Luckily, many insurers do— Cigna , Aetna , Blue Cross Blue Shield , United Healthcare , Medicaid , and Medicare all provide coverage. Lykos’ MDMA is not just a pharmaceutical—it is a package deal , where patients receive several rounds (42 hours) of therapy to prepare and “integrate” their experience on MDMA.

Medicare 80

Medicare Pharmaceuticals Regulations Medicaid 80

HIT Consultant

OCTOBER 20, 2023

can be attributed to falls, including approximately six percent of Medicare and eight percent of Medicaid expenditures. Fornari co-founded and was the CEO and medical director of Dominion Diagnostics, one of the country’s leading pharmaceutical monitoring laboratories and served there from 1997 to 2011.

Rehabilitation 105

Rehabilitation Pharmaceuticals Prevention Biotechnology 105

Home Health Care

FEBRUARY 21, 2024

Dublin, Ohio-based Cardinal Health is a distributor of pharmaceuticals and a manufacturer and distributor of medical and laboratory products. Hoopes is also thinking ahead to what the market will look like once the Centers for Medicare & Medicaid Services’ Acute Hospital Care at Home waiver expires at the end of the year. “I

Hospitals 123

Hospitals Pharmaceuticals Medicaid Home Care 123

HIT Consultant

SEPTEMBER 14, 2023

Samm Anderegg, Co-Founder & CEO at DocStation Early next year, the Centers for Medicare and Medicaid Services (CMS) will remove the application of retroactive DIR fees and move DIR fees to the point of sale instead. What opportunities will AI offer the pharmaceutical industry to make further progress concerning PBMs and their DIR fees?

Pharmaceuticals 59

Pharmaceuticals Medicaid Medicare Healthcare 59

HIT Consultant

FEBRUARY 1, 2023

Most patients with OUD diagnosis had Medicaid, were uninsured or homeless – with associated visit costs largely borne by health systems. If the payer mix remained constant, $67 billion of the expense would be borne by the Medicare and Medicaid programs. billion nationally. Analyzing the Burden of Opioid Use Disorders On U.S.

Hospitals 52

Hospitals Medicaid Rehabilitation Accountability 52

Bill Of Health

MARCH 25, 2022

Association Between Payments by Pharmaceutical Manufacturers and Prescribing Behavior in Rheumatology. Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. J Gen Intern Med. 2022 Feb 9. Epub ahead of print. PMID: 35138547. Mayo Clin Proc. 2022 Feb;97(2):250-260. PMID: 35120693. Hwang TJ, Vokinger KN.

Regulations 82

Regulations Pharmaceuticals Medicaid Health Technology 82

Bill Of Health

NOVEMBER 9, 2023

Despite the important enactment in 2010 of the Patient Protection and Affordable Care Act (ACA), which increases access to care by expanding Medicaid eligibility and protecting insurance coverage of people with pre-existing health conditions and disabilities, more than 25 million people remain uninsured. to 4 times more in the U.S.

Medicaid 62

Medicaid Pharmaceuticals Prevention Quality of Care 62

HIT Consultant

DECEMBER 15, 2022

One notable example of a data ecosystem in healthcare is Blue Health Intelligence , which has collected a database of 234 million unique patients’ medical and pharmaceutical claims from Blue Cross and Blue Shield health plans.

Pharmaceuticals 98

Pharmaceuticals Medicaid Integration Healthcare 98

HIT Consultant

MAY 30, 2023

In addition, according to experts’ estimations , 17 million people could lose Medicaid coverage in just a few months. Some telehealth services—essential to people with transportation and accessibility barriers— might become less accessible in the near future.

Prevention 98

Prevention Pharmaceuticals Primary Care Doctors 98

Healthcare ECONOMIST

MAY 18, 2023

They call for CMS (Centers for Medicare & Medicaid Services) to reconsider their coverage policies and provide Medicare beneficiaries with the opportunity to access these treatments. Actual testimony ) Dr. Darius Lakdawalla Professor of Pharmaceutical Economics and Public Policy, USC Leonard D. Actual testimony ) Dr.

Pharmaceuticals 65

Pharmaceuticals Medicare Medical Technology Primary Care 65

Healthcare ECONOMIST

FEBRUARY 24, 2023

For pharmaceuticals, the media typically reports on list prices which are analogous to the “sticker price” for cars. When you buy a car, there is the sticker price and what you actually paid after haggling with the dealer over discounts. However, what really matters is the net price, which is the price after discounts and rebates.

Medicare 94

Medicare Pharmaceuticals Medicaid 94

Sheppard Health Law

JULY 10, 2023

Public Postings Regarding Hospital Services The new Office of Healthcare Accountability must provide information on its website related to costs of common hospital procedures. Effective Date The Healthcare Accountability and Consumer Protection Act will become effective in February 2024.

Accountability 52

Accountability Pharmaceuticals Hospitals Medicaid 52

Health Populi

JUNE 24, 2021

The economic and healthcare system impacts of this were explored in the Post-Covid Healthcare Landscape , delivered by Fitch Solutions’ Jamie Davies and Beau Noafshar, leaders in the Pharmaceuticals, Healthcare, and Medical Devices groups.

Healthcare 108

Healthcare Pharmaceuticals Population Health Regulations 108

Healthcare ECONOMIST

SEPTEMBER 25, 2023

They find that: We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = −0.04 Interestingly, the authors did find that there was some evidence of quality improvement among insured non-Medicaid patients.

Quality of Care 68

Quality of Care Medicaid Quality Improvement Hospitals 68

Bill Of Health

SEPTEMBER 12, 2023

SB: Both Medicaid and the Title X program go a long way to making contraceptives available, and these same issues have to be worked out by those programs. JRJ: Now, looking to the future of pharmaceutical regulation, the FDA approval of Opill is a significant milestone, from a legal or regulatory perspective.

Pharmaceuticals 73

Pharmaceuticals Regulations Medicaid 73

Sheppard Health Law

DECEMBER 1, 2023

HHS-OIG conducted investigations resulting in 661 criminal actions against individuals related to Medicare and Medicaid, as well as 726 civil actions, including false claims, unjust-enrichment lawsuits, and civil monetary penalty settlements. Enhancing program integrity in noninstitutional care settings, such as home health and hospice care.

Telemedicine 52

Telemedicine Hospice Care Medicaid Medicare 52

Home Health Care

JANUARY 18, 2023

It entered New Mexico through its recent acquisition of Inteli-Care, a Medicaid-based home care provider that allowed it to further diversify its mostly private-pay portfolio. Close is a veteran of the pharmaceutical industry and also worked in life sciences. It has over 20 locations in California, Arizona and New Mexico.

Home Care 104

Home Care Life Sciences Pharmaceuticals Medicaid 104

Bill Of Health

MAY 19, 2022

Incremental benefits of novel pharmaceuticals in the UK: a cross-sectional analysis of NICE technology appraisals from 2010 to 2020. Direct-to-Consumer Generic Drugs: A Maverick Approach or Another Exposure of Market Failures? Ann Intern Med. 2022 Apr 19. Epub ahead of print. Polak TB, Cucchi DGJ, Darrow JJ, Versteegh MM.

Pharmaceuticals 82

Pharmaceuticals Regulations Hospitals Medicaid 82

Healthcare ECONOMIST

NOVEMBER 16, 2021

Clayton 2019 is an interesting study on the impact of drug spending on Medicaid beneficiary mortality levels. The author uses variation in the roll out of Medicaid drug coverage by state across different Medicaid eligible groups in order to isolate plausibly exogenous variation in drug expenditures.

Medicaid 53

Medicaid Pharmaceuticals 53

Healthcare ECONOMIST

FEBRUARY 6, 2023

First lets turn to Medicaid via a report by Tyrus Jackson in JD Supra , The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on January 27 to recommend that Congress grant states the ability to limit Medicaid coverage for drugs and biologicals approved under the FDA’s accelerated approval pathway.

Medicaid 60

Medicaid Medicare Regulations Pharmaceuticals 60