Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

The 2012 Supreme Court got a lot of attention for its decision to uphold most of the Affordable Care Act (ACA) health reform law in NFIB v. Sebelius. But this year’s court docket will be no dud. There will be a number of interesting and important cases for pharma...
Medicaid accounts for the largest share of state budgets and is growing still. Since fiscal year 2010, state Medicaid spending nationwide grew from 22.2 percent to about 24 percent of the average state budget, according to the National Association of State Budget Officers (NASBO). Since the recession began in...
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...
Health care quality and patient safety have become increasingly important in recent years, particularly as part of efforts to prevent wasteful spending, hospital readmissions, and medical errors. Accountable Care Organizations (ACO), health information technology (HIT), electronic health records (EHR), and new health plan reporting requirements are among the many...
Medicare program payment methods are highly complex and change constantly.  The Affordable Care Act (ACA) makes further, very significant changes to how Medicare pays hospitals, physicians, post-acute providers, and Medicare Advantage health plans.  In a series of excellent briefs, the Medicare Payment Advisory Commission (MedPAC) explains the basics of Medicare reimbusement, including...
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...
The Centers for Medicare and Medicaid Services (CMS) is working to help state Medicaid programs get the best deal possible when purchasing prescription drugs. The second phase of CMS’s Medicaid retail drug price survey will poll pharmacies on a monthly basis to create a National Average Drug Acquisition Cost...
Medicare Part D prescription drug plan formularies in 2012 covered 96 percent of the drugs most used by people eligible for both full Medicare benefits and Medicaid - full benefit dual eligibles - according to the Department of Health and Human Services Office of Inspector General (OIG). That figure is...
Pharmaceutical manufacturers face an economic transformation as payors look more toward value-based – as opposed to transactional, unit-based – models for drug reimbursement.  This value-based revenue model presents enormous implications for the future of pharma and biotech, impacting everything from innovation, clinical trials, pricing, and marketing. The Health Research Institute at PwC surveyed...

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