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Coverage and Reimbursement

Compounded drugs are a new hot issue in the pharmaceuticals industry and in Congress. There are little data about compounding pharmacies, but a new Congressional Research Service brief gives a comprehensive overview. Compounded Drugs Personalize Drug Treatments: Compounded drugs are created when a physician or pharmacist mixes or changes pharmaceuticals to...
The prices of generic drugs vs. brand-name drugs has gathered a lot of attention lately. But buying in bulk and purchasing practices can have as much of an effect on prices as drug patents do.  That’s what the Government Accountability Office (GAO) found when it compared Rx prices paid in prescription...
Hypertension, or high blood pressure, is related to several major chronic diseases. Obesity and diabetes raise your chance of developing high blood pressure, which in turn makes you more likely to suffer from heart disease and stroke. High blood pressure also becomes more prevalent with age. Those factors make high...
What's the impact on patient care, particularly prescription drug utilization, as Medicaid beneficiaries move from fee-for-service to Medicaid health plans?  This year, state Medicaid programs will spend over $22.1 billion on pharmacy benefits. This will grow to about $50 billion by 2020, according the CMS actuaries. Nearly half of Medicaid prescriptions...
Medicare Part D, the Medicare drug benefit, served roughly 31 million seniors last year. Medicare Part D is more similar to Medicare Advantage than to traditional Medicare in that enrollees can choose among several private health plans for drug coverage. The lists of which drugs Part D plans cover -...
Independent pharmacies play a central role in the U.S. prescription drug market, distributing almost one in five drugs sold in the country. But small pharmacies often do not have the resources to handle the administrative burden of filing claims with health plans or purchasing stock from prescription drug wholesalers....
Essential health benefits (EHB) will play a fundamental role in shaping health plans after 2014. Part of the Affordable Care Act (ACA), EHBs define a baseline of 10 types of services those plans must cover, including prescription drugs, hospital services, preventive or wellness services, and chronic disease management. Qualified...
When Congress enacted the Medicare Modernization Act of 2003 (MMA), it set a spending target of about $400 billion over 10 years for the Medicare Part D drug benefit, after accounting for revenues from premiums and other sources. Seven years into the program’s life, Medicare Part D spending is...
Prescription drugs often play an important role in keeping people healthy, especially for people with chronic conditions. Medicare beneficiaries with diabetes or asthma, for example, might take regular medicines to prevent emergencies that would put them in the hospital. Hospital stays, doctor’s appointments, and other medical services covered under...
As patents on brand-name drugs expire, and generic drug use increases, the United States, Europe, and Japan will account for a smaller share of worldwide spending on prescription drugs, a report from IMS Institute for Healthcare Informatics says. Yet rising incomes in countries such as Russia, China and India...

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