March 6th 2024
Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
November 14th 2023
September 18th 2023
Spending climbed by 2.7% in 2021. In 2020, it soared by 10.3%, fueled by federal government spending in response to the pandemic. The blizzard of calculations of 2021 healthcare spending by CMS’ actuaries also provides further evidence that utilization of healthcare services bounced back in 2021.
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Talking PIE, the Act, Before Thanksgiving
November 23rd 2022AMCP CEO Susan A. Cantrell spoke with Managed Healthcare Executive® about Preapproval Information Exchange (PIE) Act of 2022, which would allow drug manufacturers to share information about a drug with payers before the drug is approved. Cantrell says passage of the PIE Act would speed up patient access to new medications.
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Inflation Reduction Act and the Impact on Pharmaceutical Pricing and Investment Decisions
November 21st 2022The reference to “maximum fair price” in the act bodes poorly for manufacturers and suggests more of a take-it-or-leave-it situation rather than a negotiation where clinical evidence would be the prevailing factor in determining price.
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Healthcare Issues Took a Backseat in Midterms But Abortion Access Figured Prominently in Key States
November 9th 2022Abortion access was a key issue in Pennsylvania and other battleground states. The Affordable Care Act receded into the political background, although voters in South Dakota approved a ballot measure that expanded Medicaid, leaving just 11 states that haven't done so.
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What Will Payers Do If Courts Strike Down the ACA’s No-Cost Requirement for Preventive Services?
September 7th 2022A federal district court ruling today could jeopardize coverage of preventive services recommended by the U.S. Preventive Services Task Force. Some payers may be cautious about pulling back on full coverage of preventive services, but if the ruling stands, experts fear the undoing of a key provision of the Affordable Care Act will result in a patchwork of coverage — and a worsening of healthcare disparities.
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Low-revenue MSSP ACOs Produced Better Results in 2021 Than High-revenue ACOs: CMS
August 30th 2022The Centers for Medicare and Medicaid Services released results today showing that on a per capita basis, the net savings for low-revenue accountable care organizations (ACOs) was higher than the net savings for high-revenue ACOs.
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UCSF Research: No Synergy From Valued-based Programs for Primary Care Organizations
February 26th 2022Ideally, value-based and technology programs combine to produce better outcomes. But researchers at University of California, San Francisco, found little evidence of synergy in the meaningful use, patient-centered medical home and Medicare Shared Savings Program ACO program.
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New York Not-For-Profit Nursing Home Sales are Subject to Increased Scrutiny by the Attorney General
July 26th 2019Due, at least in part, to the substantial increase in the number of sales of New York not-for-profit skilled nursing facilities to for-profit operators since 2015, the Charities Bureau of the New York State Attorney General is subjecting such transactions to increased scrutiny, including objecting to certain of such sales, increasing the time and cost associated with such transactions.
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