In this week’s Innovation Partners BioBlog, we look at the challenges of designing new payment models for prescription drugs. The president seeks to align United States’ drug costs with those of its European counterparts; he also signed legislation this week to combat the opioid crisis. The CVS-Aetna merger continues apace, while other items of note this week include opening the doors to more telehealth coverage, the impact of a possible ACA repeal, and more. These and other top stories in this week’s Innovation Partners BioBlog.


The challenge of designing new payment models for prescription drugs

What does “value” mean when it comes to medications? In the shift towards value-based care, prescription drugs lag behind other areas of healthcare. Shifting or unclear definitions of value, as well as lack of evidence, are some of the many barriers to move prescription drugs towards the value-based model. A look at the challenges of designing new payment models for prescription drugs.
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Trump Aims To Lower Some U.S. Drug Spending By Factoring In What Other Countries Pay

The Trump Administration is looking to align American prices for cancer and arthritis medications with prices paid by European countries. America typically pays more for the same or similar drugs as the European nations pay. The proposed changes are related to Medicare Part B that pays for medications received in doctor’s offices or hospitals.
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CMS proposed rule expands telehealth for Medicare Advantage plans, beefs up payment audits

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on Friday that would allow Medicare Advantage plans greater flexibility to offer telehealth benefits.
The proposed change would allow telehealth benefits to be offered to all starting in 2020 regardless of location. Industry groups have pushed the government to rethink their rules around telehealth benefits. Telehealth enables many with chronic illnesses to remain at home for care rather than in hospitals.
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Administration Announces Proposed Model to Address Prescription Drug Costs

On October 25, 2018, CMS released the International Pricing Index Model for Medicare Part B Drugs, an advanced notice of a proposed rule that, if implemented, would establish a pilot program to test ways to lower the costs of drugs. Provisions in the proposal include benchmarking some part B drug prices against other countries and changing how providers get paid for administering drugs to patients. The proposal is part of President Trump’s efforts to lower drug costs and reduce out of pocket costs.
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Confidence remains in CVS-Aetna deal despite pushback from New York regulators

The CVS-Aetna deal faces its last big hurdle: New York State’s approval. Despite some backlash from government regulators and harsh statements, experts predict the deal will go through. A look at the status of the CVS-Aetna deal and the challenges faced by the proposed consolidation.
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Amazon, Walmart, Cigna among companies announcing commitment to opioid crisis as Trump signs new law

Amazon, Cigna, CVS Health, Rite Aid, Walgreens, and Walmart pledged varying levels of support for the Trump Administration’s efforts to combat the opioid crisis. The president signed the Support for Patient and Communities Act this week while groups at each of these companies pledged support for programs at the Veterans Administration, free disposal sites for prescription drugs, and more.
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ACA repeal would impact 102M people with pre-existing conditions

More than half of Americans who are not enrolled in Medicare or Medicaid have pre-existing conditions. For these people, repealing ACA would leave them potentially without coverage. An Avalere analysis indicates that 102 million people would be negatively impacted by the repeal of ACA due to pre-existing conditions that might deny them insurance. This is one of the major issues concerning Americans when it comes to healthcare, the Avalere report shows.
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