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Healthcare News Spotlight: August 26

Prescription Drug Medical Costs Less Problematic Due to ACA

New research shows that more Americans have been able to afford the medical costs of prescription drugs since the passage of the 2010 Patient Protection and Affordable Care Act as well as the 2003 Medicare Modernization Act. The research comes from Washington State University and shows a continuous drop in the number of people unable to afford the costs of prescription drugs in recent years, according to a press release from the university. At this point in time, there are still 20 million Americans reporting that they have difficulty with paying for their prescription medication. However, the researchers discovered that in 2009, as many as 25.1 million American citizens went without filling a prescription over the prior 12 months due to high medical costs they were unable to afford. Since the recession of 2009, this number has dropped significantly. Read more: HealthPayer Intelligence.

States Eye Health Insurance Regulations to Control Drug Costs

Healthcare insurance companies are actively fighting to keep drug costs low for their members and for their own bottom lines. Now a new policy brief offers state policymakers tips on how to shift more of the costs to payers in an effort to protect consumers. The brieffrom the National Association of Insurance Commissioners outlines several regulations policymakers can adopt to ease consumers’ cost burdens, including: Imposing restrictions on how many cost-sharing tiers per plan insurers can use, as in the case of standardized plans in New York, Vermont and Massachusetts, where ACA plans are limited to three tiers. Policymakers should also prohibit payers from switching a drug they cover to a costlier tier over the course of the plan year. Read more: FierceHealthcare.

Fewer Than a Third of Medicare ACOs Received Bonuses Last Year

The mixed results for Medicare accountable care organizations continued last year with fewer than one-third of them qualifying for bonus payments, the CMS said Thursday. The news comes as the administration is preparing providers for the new Medicare reimbursement program known as MACRA, which is set to begin collecting data in January. It shifts away from fee-for-service payments and toward value-based payments, thus promoting the use of programs like ACOs. ACOs receive bonuses from shared savings based on formulas that account for performance and quality marks. The CMS recently announced that, starting next year, regional spending factors will also be incorporated. The administration has a goal of having 50% of traditional Medicare payments flowing through alternative payment models by 2018. Read more: Modern Healthcare.

Medicare May Increase Access to Physician Assistants, Nurse Practitioners

The Obama administration is proposing to lift a ban preventing physician assistants and nurse practitioners from caring for Medicare patients in their homes rather than the more expensive nursing facility or other inpatient care center. The Centers for Medicare & Medicaid Services has published a proposed rule to amend the Program of All Inclusive Care for the Elderly known as PACE, which is a program that helps seniors enrolled in Medicare as well as certain poor Americans covered by Medicaid gain access to services in their own homes. It could be implemented to allow Medicare reimbursement for these primary care providers within the year. Read More: Forbes.

FDA and Industry Groups Announce Tentative Accord to Reauthorize Medical Device User Fee Agreement

The US Food and Drug Administration (FDA) announced that it has reached an agreement in principle with representatives from the medical device industry and laboratory community on proposed recommendations for the fourth reauthorization of a medical device user fee program. Under the new draft of the Medical Device User Fee Agreement (MDUFA IV), the FDA would be authorized to collect $999.5 million in user fees plus adjustments for inflation over 5 years starting in October 2017. 

According to the FDA, this funding would provide critical resources to the agency’s medical device review program. Details of the draft agreement will be published for public comment in the coming weeks, and the final recommendations are scheduled to be delivered to Congress in January 2017. Read more: Endovascular Today.

CMS Releases Second Annual Prescription Drug Cost Data

The Centers for Medicare and Medicare Services has released privacy-protected data on the prescription drugs that the program covered under the Medicare Part D Prescription Drug Program in 2014. The 2014 data set contains information from over 1 million healthcare providers who collectively prescribed approximately $121 billion in prescription drugs that were covered under the Medicare Part D program. This represents a 17 percent increase compared to the 2013 data set. CMS believes that, with two years of data, “it will now be possible to conduct analyses of trends from 2013 to 2014 as well as to conduct a wide array of analyses that compare prescribing habits for specific providers, brand versus generic drug prescribing rates, and state- and local-level differences in drug utilization and costs.” Read more: Health Data Management.

Correlation Between Improved Health Outcomes, Medicaid Expansion Found

A study published by JAMA Internal Medicine found a correlation between improved health outcomes and Medicaid expansion among low-income U.S. adults, including a 22.7 percentage-point reduction in the uninsured rate and increased access to healthcare services. Researchers compared data from November 2013 through December 2015 on U.S. citizens in Kentucky, Arkansas, and Texas aged 19 to 64 years old with incomes below 138 percent of the federal poverty level. The objective of the study was “to assess changes in access to care, utilization, and self-reported health among low-income adults in three states taking alternative approaches to the ACA.” The study chose those three states as Kentucky expanded its Medicare coverage in 2014, Medicare funds were used to purchase private insurance for low-income adults in Arkansas, and Texas experienced no expansion at all. Read more: Health IT Outcomes.

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