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CMS Issues Final Rules, UnitedHealth’s Business Moves, and Much More

IP Blog | Innovation Partners | November 12, 2017


Pedestrians pass in front of a CVS Health Corp. store in downtown Los Angeles on Oct. 27. (Christopher Lee/Bloomberg via Getty Images)

This week’s BioBlog takes a look at UnitedHealth’s business moves. While all eyes have been on Amazon, UnitedHealth is, in fact, taking up more market share. In addition to business news, we take a look at the new CMS final rules and their impact, as well as other important industry and business news for healthcare, all in this week’s BioBlog from Innovation Partners.

Health Companies Race To Catch UnitedHealth As Amazon Laces Up

Although Amazon has been under scrutiny lately for its steps into the healthcare world, others are watching UnitedHealth Group. UnitedHealth currently ensures 45 million Americans, but it is making inroads into pharmacy management, as well as other areas of healthcare. Optum, its prescription drug unit, fills more than 100 million prescriptions a month. A look at UnitedHealth’s growth and its impact.

CMS Issues Final Rules Outlining 2018 Physician Reimbursement and the Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) released its final rules outlining changes to the Quality Payment Program (QPP) and the Medicare Physician Fee Schedule (MPFS) for 2018. ASCO is still analyzing the final rule and assessing its impact. A preliminary review indicates that it might lower reimbursements to such a degree that it could further reduce them such that they are inadequate for the delivery of high-quality, high-value cancer care.

CMS Finalizes 340B Cuts, Revisions to 14-Day Rule

CMS has finalized a proposal to cut reimbursement for separately paid drugs under the 340B Drug Pricing Program (340B) from Average Sales Price (ASP) plus 6 percent to ASP minus 22.5 percent. Rural Sole Community Hospitals, PPS-exempt Cancer Hospitals, and Children’s Hospitals will be exempt from this policy in 2018. The final HOPPS rule is available online as of November 1, and will be published in the Federal Register on November 13.

Republican bill would get rid of tax credits for rare disease drugs

A new Republic bill would eliminate tax credits for drugs developed to treat rare diseases. Currently, a tax credit of up to 50% is allowed. The new bill would save U.S. tax payers $54 billion in revenue over the next decade, but might stifle drug development for rare diseases.

November 8: Controversy Heats Up Over Pharmacy Benefit Manager DIR Fees

Small and specialty pharmacies are complaining about pharmacy benefits managers again. Complaints include controlling formularies, lack of transparencies, and retroactively applying direct and indirect remuneration fees (DIR) to pharmacies. A paper commissioned by the Community Oncology Alliance and prepared by Frier Levitt law firm outlines how the original DIR fees as payments or other reimbursement received by PBMs from a variety of sources to lower the ultimate “true cost” of a medication. According to the paper, this transitioned into the “backdoor” fees by PBMs on pharmacy providers after a drug claim is submitted and paid out to a pharmacy

Cancer Care That Knows No Boundaries: NCCN Guidelines Customized for Use in Africa

A new collaborative venture seeks to improve cancer care for people throughout Africa. The NCCN Harmonized Guidelines™ for Sub-Saharan Africa seeks to provide guidelines for cancer care to o give patients and physicians a framework for delivering effective clinical care. The guidelines are based on the current NCCN Guidelines.

GSK grabs Roche veteran and Calico scientist Barron as new R&D head

GlaxoSmithKline has hired drug industry scientist Hal Barron to be its research head. Barron most recently worked for Roche and Calico. He will replace Patrick Vallance. Vallance is moving to the position of chief scientific adviser to the British government.

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