Policy and Legislation
Some drug companies pay less than what they would otherwise owe by introducing a new drug formulation, HHS Secretary Alex Azar says.
Administrator Seema Verma says it's time for ACOs to take on downside risk, in a proposal that would save Medicare $2.2 billion over 10 years.
The 2018 benefit year will now determine risk adjustment payments to insurers, using the statewide average premium.
Starting in 2019, insurers may use step therapy to choose the least expensive drug first before moving on to another prescription.
CMS is finalizing the elimination the 25 percent threshold that reduces reimbursement for long-term hospitals.
Price increases have been the biggest driver, with medical costs, prescription drug costs and physician and clinical services all playing a part.
Some stakeholders say short-term plans will destabilize ACA market, but these plans are not expected to divert consumers already enrolled, HHS officials say
Announcement comes less than two months after a scathing report from the Office of the Inspector General showing skyrocketing Medicare Part D drug spending.
There may be multiple drugs on the market that have already been shown to be better than the standard, and drugs may even be approved without any comparisons.
Under the Wisconsin Health Care Stability Plan, the state pays for 50 percent of the cost of claims between $50,000 and $250,000.