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...
Kip Piper -
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...
Medicare Reimbursement: Medicare Payment Methods for Providers, Medicare Advantage Plans, and Medicare Part D Drug PlansKip Piper -
Medicare reimbursement methods are highly complex and constantly changing. Here are a series of concise briefings on Medicare payment policy for healthcare providers, Medicare Advantage plans, and Medicare Part D drug plans. These primers on Medicare payment basics are courtesy of the outstanding staff at the Medicare Payment Advisory Commission...
Pharmaceutical Payment: Pharma and Biotech Market Shifting to Value or Outcomes-Based Drug Revenue ModelKip Piper -
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...
Electronic prescribing in the U.S. is becoming mainstream, with e-prescribing use by physicians quadrupling since 2008. Medication adherence is increasing as a result of increased use of eRx. The National Progress Report on E-Prescribing and Interoperable Healthcare Year 2011, a report by Surescripts, provides interesting information on e-prescription use, adoption, and impact on...
Kip Piper -
A new study highlights interesting health care cost and utilization trends for Americans under age 65 with employer-sponsored health coverage. The Health Care Cost Institute (HCCI) analyzed data from Aetna, Humana, and United HealthCare, assessing price and utilization levels and changes, in their publication, Health Care Cost and Utilization Report: 2010....
Kip Piper -
Care coordination is a process that ensures a patient’s health services and information sharing preferences and needs are met. Care coordination, a critical component during the nation’s current shift from a fragmented system toward one that stresses accountability and continuity, is primarily accomplished by people as opposed to technology....
Comparative Effectiveness Research: How Agency for Healthcare Research and Quality Spent $474 Million in ARRA FundsKip Piper -
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 million went to HHS’s Agency for Healthcare Research and Quality (AHRQ) to support...
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and BudgetKip Piper -
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...
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