To assess how changes in OPPS payment for reimbursement of drugs under the 340B program would affect hospital reimbursement and Medicare Part B beneficiary cost sharing, Avalere estimated the impact of increasing reimbursement for 340B drugs in Medicare Part B to ASP + 6%. The analysis finds that most hospitals would see overall payment decreases, while payments would be subject to higher cost sharing.
Hospital spending has continued to grow rapidly (by more than six percent annually), both before and during the pandemic, and most recently represented $1.3T, equivalent to 31 percent of total national health care spending and almost seven percent of the U.S. Gross Domestic product.1 The steady growth and consolidation of the hospital sector has led a range of stakeholders to demand more transparency and accurate price reporting to better inform decision-making.2 It has also raised serious questions about the degree to which deep 340B Drug Pricing Program discounts may have fueled this s growth and consolidation.3
PHARMACY BENEFIT MANAGERS use measures like the medication possession ratio (MPR) as a performance/quality metric to evaluate specialty pharmacies and assess direct and indirect remuneration clawback fees. Abundant evidence shows that measuring MPR does not correlate with patients’ experiences while on oral cancer oncolytics and does not accurately reflect their clinical outcomes. The authors demonstrate that as an alternative to MPR, the Florida Cancer Specialists & Research Institute’s Rx To Go in-house pharmacy offers value; it uses a multifaceted approach to comprehensively evaluate the services that specialty oncology pharmacies provide to patients with cancer who are being treated with oral oncolytics.
The Honorable Chiquita Brooks-LaSure, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-4192-P P.O. Box 8013 Baltimore, MD 21244-8013 Re: CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P) Dear Administrator Brooks-LaSure: On behalf of the Board of Directors of the Community Oncology Alliance (“COA”), we
Executive Summary Over the past year, an alarming trend has emerged in the healthcare context that threatens to disrupt the entire delivery model for a large subset of our nation’s most vulnerable patients – seniors enrolled in the Medicare Part D Program receiving complex medications for live-saving treatments. This trend – unilaterally-imposed by
There is growing awareness of the problems and pitfalls with Pharmacy Benefit Managers (PBMs) in the United States health care system.
To assess the impact of the Oncology Care Model (OCM), the Community Oncology Alliance (COA) conducted a survey of member practices. The OCM is a federal payment and delivery reform initiative run by the Centers for Medicare & Medicaid Services (CMS) Innovation Center’s (CMMI) oncology. COA launched a major support initiative effort behind the
Introduction Prior authorization of medical procedures, services, and medications have been a standard requirement for health care providers for decades. Rising health care costs, specifically the escalating cost of cancer drug therapies, have led to a renewed focus by payers, providers, and policy makers on prior authorization. Similarly, the challenges and frustrations of the
Introduction The United States spends 17.7% of its GDP on health care related expenditures, far above its developed market peers, who generally spend no more than 12% of their GDP. This excess health care spending added costs are an enormous burden on the U.S. economy and ‘crowd out’ important necessary spending on areas such
1,748 Community Oncology Clinics and/or Practices Have Closed, Been Acquired by Hospitals, Merged, or Reported Financial Struggles Since 2008 Significant Increase in Community Oncology Practice Mergers and/or Acquisitions with Other Non-Hospital Practices or Corporate Entities as Hospital Acquisitions Continue The 2020 Community Oncology Alliance (COA) Practice Impact Report tracks the changing landscape of community
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