Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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In Developing Strategic Framework for HIT Regulation, HHS Continues to Focus on HIT Functionality
On April 3, HHS released a draft report with proposed strategies and recommendations for health information technology (HIT) regulation.
Avalere Analysis: Ten States Driving New Medicaid Enrollment
700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.
New Medicaid Eligibles in Seven States Will Have a Unique Benefit Package
In 2014, most states are choosing to cover new Medicaid eligibles with the same benefit package that current eligibles receive.
Temporary SGR Bill Passed With One-Year Doc Pay Patch, ICD-10 Delay
On March 31, the Senate passed the "Protecting Access to Medicare Act of 2014," which was passed in the House last week, to provide a temporary fix to the Sustainable Growth Rate (SGR) formula.
USPSTF to Update Its Recommendation on Screening for Depression in Adults; Posts Draft Research Plan for Comment
On March 27, the United States Prevention Services Task Force (USPSTF) released for public comment a draft research plan, "Primary Care Screening for Depression in Adults," taking the first step in the process to update its recommendation released in 2009.
FDA Advisory Panel Unanimously Recommends Exact Sciences’ Cologuard®, the First Product to Undergo FDA-CMS Parallel Review
On March 26 and 27, FDA's Advisory Panel reviewed two DNA-based colorectal cancer (CRC) screening tests, Epigenomics-Epi proColon® Septin 9 test and Exact Sciences-Cologuard®.
OIG Finds Increase in Dialysis Facility Acquisition Costs for ESAs Over Three-year Period, Decrease in Costs for Most Other Drugs; Could Signal Lower Market Basket for 2015 and Beyond
On March 25, OIG released an updated report on Medicare payments for End Stage Renal Disease (ESRD) drugs.
Observations As ACA Open Enrollment Closes
As 2014 open enrollment comes to a close, core issues (listed below) associated with exchange implementation remain unsettled.
United Healthcare Network Retail Pharmacies to no Longer Accept Manufacturer-Provided Retail Copay Coupons
Beginning July 1, retail pharmacies in United Healthcare's (UHC) network will no longer accept manufacturer-provided retail copay coupons.
House Releases SGR Bill With 1-Year Doc Fix; Extenders, ICD-10 Delay and Major Lab Payment and ESRD Changes Included
On March 25, the House released the bill text for the "Protecting Access to Medicare Act of 2014," which provides a temporary fix to the Sustainable Growth Rate (SGR).
CMS Implements Part B Drug Payment Policy with No Public Warning
On March 18, the HHS OIG released a report providing an overview of specific Medicare Part B drugs where the Average Sales Price (ASP) exceeded the Average Manufacturer Price (AMP) by at least five percent in 2012.
Avalere Medicaid Expansion Map – March 2014
27 states and Washington, D.C. are currently expanding their Medicaid eligibility.
Employers Value Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) As Coverage Option for Retirees
More than 2.7 million retirees receive health insurance coverage from their employer through a Medicare Advantage Employer Group Waiver Plan (MA-EGWP).
SGR Bills Aplenty, But Doc Fix Extension Seems Imminent
The bipartisan, bicameral legislative framework for a repeal of the Sustainable Growth Rate (SGR) formula and shifts toward quality/value-based payment and adoption of alternative payment models for physicians has been primed since early February.
Avalere Analysis: Consumers Face More Hurdles to Accessing Drugs in Exchange Plans Compared to Employer Coverage
A new analysis from Avalere Health finds that consumers purchasing insurance through exchanges are twice as likely to face utilization management controls on prescription medications compared to people enrolled in employer-sponsored insurance plans.
Enrollment Tops 4.2 Million as Exchanges Begin 2015 Preparations
With only two weeks left of 2014 exchange open enrollment, issuers and states are deeply engaged in maximizing enrollment before the end of the month.
FDA Releases Draft Guidance for Conducting Bioavailability and Bioequivalence Studies
On March 18, FDA released draft guidance containing recommendations for sponsors and new applicants preparing bioavailability (BA) and bioequivalence (BE) data for products in investigational new drug applications (INDs), new drug applications (NDAs) and NDA supplements.
HHS Publishes Interim Final Rule on Third Party Payments
On March 14, HHS published an interim final rule on third party payments requiring qualified health plans (QHPs) and standalone dental plans (SADPs) to accept third party payments on behalf of enrollees from the Ryan White program, Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs.
CMS Releases Proposed Rule on Exchange and Insurance Market Standards for 2015 and Beyond
On March 14, CMS released the Exchange and Insurance Market Standards for 2015 and Beyond proposed rule.
CMS Offers End-to-End Testing of ICD-10 Claims and Beta Software to Support Providers through the ICD-10 Implementation
From July 21 to 25, CMS will conduct end-to-end testing on the International Classification of Disease, Tenth Revision (ICD-10) coding system.