Healthcare Law Blog

JUNE 2, 2023

In the underlying Seventh Circuit cases, relators alleged that retail pharmacies had knowingly submitted false reports of their Usual and Customary (“U&C”) drug prices to the government for reimbursement under Medicare Part D and Medicaid, because the reports allegedly did not account for discounted drug prices offered through certain prescription (..)

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Health Care Law Brief

JANUARY 19, 2022

On December 31, 2021, New York Governor Kathy Hochul signed landmark legislation to increase the transparency of prescription drug pricing and to establish requirements on pharmacy middlemen. Medicare and Medicaid have had similar price transparency rules, but now those rules will apply across all lines of business in New York.

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Health Populi

OCTOBER 28, 2019

When asked what factors contribute to rising health care costs in America, most consumers cite the cost of prescription drugs. Taken together, these two data points demonstrate the potent political import of prescription drug prices as the U.S. approaches the 2020 Presidential election.

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Health Populi

OCTOBER 24, 2022

health care system not seen since the 1968 creation of Medicare, coupled with decreased reimbursement due to health care reform. The XY supply demand curve shown above from Trilliant’s analysis illustrates a government price ceiling shock to health care pricing.

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HIT Consultant

FEBRUARY 22, 2024

What You Should Know: Waltz Health, a digital health company developing smarter, technology-enabled ways to price, distribute and prescribe medications, today announced its entry into the Medicare market. The struggle with out-of-pocket drug expenses affects millions of Medicare beneficiaries annually, particularly underserved groups.

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Health Populi

JANUARY 18, 2019

As the Harvard Chan-POLITICO study points out, prescription drug costs are top-of-mind for health consumers in America. As patients continue to morph into consumers who pay for health care services, they are seeking price transparency — but not finding it so easy. And see here on JD Supra for more details on the rules.

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Health Populi

OCTOBER 8, 2019

Pricing failure, the second big waste factor, is predominantly challenged by pharmaceutical/prescription drug pricing based on this research. The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027.

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Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

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HIT Consultant

JANUARY 21, 2022

An AARP report finds in 2020 that the price of hundreds of brand-name medications rose more than twice as fast as inflation. Part of Biden’s Build Back Better plan would enforce an annual out-of-pocket cap on what people on Medicare pay for their prescription drugs. Partnership Details.

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Hall Render

FEBRUARY 25, 2022

The 55 hospitals penalized by Medicare 8 years straight over patient complications. Medicare penalizes 40 hospitals in Florida for patient safety. Whitmer signs bills designed to lower prescription drug prices in Michigan. Ohio ASC, health system to pay $3M to settle improper Medicare claims allegations.

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Hall Render

APRIL 12, 2024

New president tapped to lead major hospital system in Denver area New president to lead opening of $650M hospital in Wheat Ridge Telehealth program offers support to forensic nurses Colorado Medicaid program settles lawsuit over lack of mental health care for children Colorado is trying to cut prescription drug prices.

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Hall Render

JULY 22, 2022

CMS releases Medicare OPPS and ASC proposed rule. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. Rising prescription drug prices contributed to 49% jump in Oregon healthcare costs over 6-year period: report. CMS pitches outpatient payment rule. CMS proposes 2.7% PENNSYLVANIA.

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Hall Render

FEBRUARY 18, 2022

13-year Medicare payment dispute will return to HHS, court rules. A layoff list, expired medicine, neglected patients: Illinois hospital loses Medicare contract. Bill on prescription drug pricing inspires support from Maine residents, opposition from pharmaceutical industry. 64M VA health clinic opens in Portland.

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Health Law Advisor

MAY 22, 2023

1339) reflects the overarching legislative push by members from both sides of the aisle and chambers of Congress to address drug pricing issues through federal fixes to the PBM framework. Unlike the IRA, which targeted the Medicare program, the provisions of S. 1339, adding several new amendments to create the version of S.

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Health Populi

MAY 8, 2019

In 2018, we saw more incentives to inspire adherence to prescription drug regimens, particularly in Medicare Part D along with increasing focus by pharmacists and providers. For people enrolled in Medicare Part D, 20% faced over $500 in OOP costs. A cost of $125 or more yields abandonment of at least 50%.

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Medval Compliance Blog

SEPTEMBER 1, 2021

Recognizing the mounting attention given to hidden fees and surprise billing, on June 24, 2019, former President Trump signed an executive order (EO) directing the Department of Health and Human Services (and additional agencies) to take steps to improve price and quality transparency in healthcare. Medicare Set-Aside Considerations.

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Health Populi

APRIL 30, 2021

As such, the debate on prescription drug pricing in the U.S. is heating up, with President Biden mentioning the scenario of Medicare negotiating drug prices with pharmaceutical manufacturers in his latest speech measuring progress at 100 days in the White House.

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Health Populi

DECEMBER 30, 2019

Humana’s Bold Goal initiative targeting Medicare Advantage enrollees. Even seemingly popular plan ideas like prescription drug pricing and coverage for pre-existing conditions can’t get traction in Congress or through the White House’s executive pen.

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Jane Sarashon

SEPTEMBER 9, 2022

The decline of the pharma industry reputation is an important reality-check here given that even Republican voters have been keen to see greater regulation of prescription drug pricing in recent health tracking polls.

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Hall Render

NOVEMBER 11, 2022

Physician leaders balk at Medicare 4.48% physician fee cut. Bright Health exiting Florida Medicare Advantage market. in prescription drug pricing case. Duke LifePoint hospital at risk of losing its Medicare contract — again. Wilson hospital again facing federal threat to end Medicare contract.

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Health Populi

MAY 14, 2018

This is what happened to pharma stock prices on Friday after President Trump and Secretary of Health and Human Services Alex Azar outlined their new policies focusing on prescription drug prices. ” These prescriptions for lower pharma costs contrast with what most U.S. The graph is the Nasdaq U.S.

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Hall Render

JUNE 23, 2023

NATIONAL AHA, CHA respond to Human Rights Watch report on nonprofit hospitals AMA urges end of noncompete clauses in physician contracts Amazon launches $100M generative AI center, targeting healthcare As urged by AHA, Supreme Court rules government can dismiss FCA case over relator’s objection Biden announces leader of the CDC Bill would give Biden (..)

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Hall Render

FEBRUARY 24, 2023

NATIONAL Addressing Staff Burnout In Healthcare Design Amazon completes $3.9B Staff shortages could spur next public health crisis, Baystate Health CEO warns CommonSpirit, Mass General, Moffitt execs to judge telehealth challenge Brigham and Women’s, AI company get $2.5M grant to improve early cognitive decline detection via EHRs How Mass.

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Health Populi

FEBRUARY 8, 2023

We capped the cost of insulin at $35 a month for seniors on Medicare. But there are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives. For example, one in ten Americans has diabetes. Not anymore. Let’s finish the job this time.

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Health Populi

OCTOBER 12, 2018

Since the CVS+Aetna announcement last December, the Kaiser Family Foundation ran some numbers on how the merged organization could impact Medicare — a key payor for both health insurance and prescription drugs under Part D. The Academy convened a team with experience and gravitas to inform this report.

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Kaiser Health News

JULY 21, 2022

But work continues, particularly on a Senate bill that could, for the first time, allow Medicare to negotiate prescription drug prices and cap seniors’ out-of-pocket medication costs. The bill, which hasn’t been released in full, will include only those provisions that have been approved by Sen.

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Health Populi

AUGUST 3, 2018

voters, across the three-party landscape, agree on two healthcare issues this year: coverage of pre-existing conditions, and lowering the consumer-facing costs of prescription drugs. This is the tactic that most Americans say could lower prescription drug prices. There’s growing evidence that a majority of U.S.

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Health Populi

MARCH 13, 2018

President Trump made clear on the campaign trail and in his interview with TIME magazine as Person of the Year that pharmaceutical companies’ pricing needed to be reined in using government pressure.

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Health Populi

JUNE 18, 2020

The authors, Dr. Naci and Dr. Kesselheim, are affiliated with the London School of Economics and Brigham and Women’s Hospital in Boston, note that 1% of medicines dispensed under Medicare Part D and Medicaid accounted for nearly $1 in $3 of drug spending in each program in 2015. bn to $32.8 bn to $9.9 bn for Medicaid.

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Health Populi

APRIL 26, 2019

Health Populi’s Hot Points: The third chart illustrates that pharma pricing is a unifying force across older voters across the three political parties. consumers to import cheaper prescription drugs from other countries. While deep understanding of how U.S.

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Prescription Drug Pricing Governance Medicare Medicare 56

Health Populi

APRIL 10, 2019

In typical markets, as products mature and get mass adoption, prices fall. But then prescription drug pricing doesn’t conform with how typical markets work in theory. The study analyzed medical claims for millions of patients, both commercially insured and enrolled in Medicare. of family income.

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Jane Sarashon

DECEMBER 20, 2023

Complementing this effort, Kroger also launched a personalized health and nutrition program collaborating with Soda Health earlier in December – importantly, aimed at people enrolled in Medicaid and Medicare programs.

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Jane Sarashon

DECEMBER 6, 2023

The future of Medicare and Medicaid as well as access to mental health care also rank high among two-thirds of U.S. Stay tuned to IRA components addressing prescription drug costs, and Medicare and Medicaid status (provider payments for the former, state-level moves for the latter).

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Health Populi

MARCH 6, 2019

is prescription drug prices — that they’re too high, that the Federal government should negotiate to lower costs for Medicare enrollees, and that out-of-pocket costs for drugs should be limited. The biggest culprit/contributor to prescription drug prices? consumers were asked.

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Health Populi

OCTOBER 15, 2021

Drug price negotiation, say by the Medicare program, is a unifying public policy in the current era of political schisms in America, based on the findings in a special Kaiser Family Foundation (KFF) Health Tracking Poll conducted in late September-early October 2021.

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Kaiser Health News

JANUARY 25, 2024

But Biden may be gathering momentum himself from an unexpected source: Drug industry lawsuits challenging his administration’s Medicare price negotiation plan could draw attention to Biden’s efforts to combat rising prescription drug prices, a major pocketbook issue for many voters.

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Kaiser Health News

AUGUST 12, 2022

First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. Never before have we been able to negotiate prescription drug prices. Those prices would take effect in 2026.

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