HHS seeking positive feedback on benefits

January 1, 2011

The feds are moving aggressively to breathe life into many new programs authorized by the Patient Protection and Affordable Care Act, now nearly a year old

WASHINGTON-The feds are moving aggressively to breathe life into many new programs authorized by the Patient Protection and Affordable Care Act (PPACA), now nearly a year old. A number of new initiatives aim to make healthcare more affordable and available, and the Obama administration wants the public to appreciate these gains.

The Department of Health and Human Services (HHS) issued guidance clarifying which firms are eligible for the small-business tax credits to encourage them to provide health coverage for workers and how to tap credits-up to 35% of employer premiums this year.

A high-profile preventive care program and increasing coverage in the donut hole will benefit Medicare patients. The Centers for Medicare and Medicaid Services (CMS) is highlighting how PPACA eliminates cost-sharing for certain services, such as cancer screening tests and check-ups. A new drug discount program will provide a 50% discount on brand-name prescription drugs filled by patients who fall into the drug plan coverage gap.

More high-income beneficiaries (couples earning $170,000 or more) will pay higher premiums for Medicare Part B. The Center for Medicare and Medicaid Innovation (CMMI) has mapped plans for testing new payment and delivery system models designed to reduce costs while improving quality of care.

Another potential cost-saving initiative for government agencies, health plans and payers is the PPACA provision authorizing the Food and Drug Administration (FDA) to establish a pathway for bringing less costly generic versions of biotech therapies, or "biosimilars," to market. FDA has consulted brand and generic drug manufacturers, providers and research experts to devise standards for testing the safety and efficacy of such products.

The aim is to spur the development of high quality, but more affordable, therapies, a goal that will be increasingly important as more high-cost specialty drugs gain market approval.

The federal program for expanding access to comparative effectiveness research (CER) also is moving forward. The governing board for the Patient-Centered Outcomes Research Institute (PCORI) is up and running and planning to launch several early initiatives to fill information gaps and clarify PCORI's mission. The aim is to provide patients and providers with information on effective treatment options, and reduce spending on inappropriate services and products in the process.