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Leslie Small

Recent Posts

Perspectives on Changes to Addiction Treatment Privacy Rules

Posted by Leslie Small on Oct 3, 2019

A recent federal proposal — which would loosen privacy rules surrounding substance use disorder (SUD) treatment — is being applauded by health insurer trade groups. But some advocates are worried about potential harms to patients, AIS Health reported.

At the center of the debate is legislation enacted in the 1970s and the subsequent regulations implementing that law, known as 42 CFR Part 2, which was designed to protect the confidentiality of SUD patient records created by federally funded treatment programs. Under the proposed changes to 42 CFR Part 2, opioid treatment programs would be able to enroll in state prescription drug monitoring programs and submit the dispensing data for controlled substances consistent with applicable state laws. SUD patients also would be able to consent to disclosure of their Part 2 treatment records to an entity, without having to name a specific person.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Does New Medicare Plan Finder Make Part D Plans Tougher to Parse?

Posted by Leslie Small on Oct 1, 2019

Some Medicare experts are expressing concern and frustration about changes to the Medicare Plan Finder that may make it more difficult for beneficiaries to find the best Part D plan for their unique circumstances, AIS Health reported.

For example, the version of the new plan finder that CMS debuted does not include the ability to sort Part D plans based on a beneficiary's total out-of-pocket drug costs (including plan premium) for the rest of the year, says Ann Kayrish, who is the National Council on Aging’s senior program manager for Medicare.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for High-Touch Care Management for Chronic Conditions

Posted by Leslie Small on Sep 26, 2019

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

For specialty PBM AscellaHealth, LLC, that means harnessing a variety of resources to help better manage treatment for hemophilia, a notoriously expensive disease state.
 
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Topics: Industry Trends, Market Access, Data & Analytics

Perspectives on Million-Dollar Treatments

Posted by Leslie Small on Sep 19, 2019

For large, self-insured U.S. employers, their No. 1 concern related to pharmacy benefits is how to finance treatments that come with seven-figure price tags.

That's one finding of the National Business Group on Health (NBGH) 2020 Large Employers' Health Care Strategy and Plan Design Survey, AIS Health reported. Among the 147 employer respondents, 86% said they were either concerned or very concerned about "the impact of million-dollar treatments getting approved by the FDA."
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: New Solutions to Finance High-Cost Treatments May Raise New Questions

Posted by Leslie Small on Sep 17, 2019

With concerns mounting about how health plan sponsors will pay for breakthrough treatments with ultra-high price tags, some major insurers are offering up new solutions aimed at easing that burden, AIS Health reported.

Cigna Corp. "appears at the forefront" of initiatives to cope with super-high-cost drugs, as Citi analyst Ralph Giacobbe puts it, given that the firm recently introduced a new solution that would help clients pay for and manage two gene therapies: Luxturna and Zolgensma

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Topics: Specialty, Market Access, Product Release, Provider, Payer

Radar On Market Access: Insurers Welcome Changes to Addiction Treatment Privacy Rules

Posted by Leslie Small on Sep 10, 2019

A recent federal proposal — which would loosen privacy rules surrounding substance use disorder (SUD) treatment — is being applauded by health insurer trade groups. But some advocates are worried about potential harms to patients, AIS Health reported.

At the center of the debate is legislation enacted in the 1970s and the subsequent regulations implementing that law, known as 42 CFR Part 2, which was designed to protect the confidentiality of SUD patient records created by federally funded treatment programs. Under the proposed changes to 42 CFR Part 2, opioid treatment programs would be able to enroll in state prescription drug monitoring programs and submit the dispensing data for controlled substances consistent with applicable state laws. SUD patients also would be able to consent to disclosure of their Part 2 treatment records to an entity, without having to name a specific person.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Pill Club, CVS Dispute Raises Larger Questions

Posted by Leslie Small on Sep 5, 2019

CVS Health Corp.'s Caremark division came under fire recently when Pill Club, a birth-control-delivery startup, accused the PBM of restricting access to contraceptives amid a reimbursement dispute. The dustup even spilled onto social media, with the hashtags #CVSDeniesCare and #BoycottCVS trending on Twitter on Aug. 15.

While the dust has since settled, experts tell AIS Health that the incident raises bigger questions, including whether social media will increasingly be used by smaller fish in the pharmacy supply chain to amplify their negotiating clout with powerful PBMs.
 
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Topics: Market Access, Provider, Payer

Radar On Market Access: Pediatric Managed Medicaid ACO Leverages Pharmacists to Improve Care

Posted by Leslie Small on Sep 3, 2019

For a pediatric accountable care organization (ACO) that contracts with Ohio's Medicaid managed care plans, improving care for children would be a much more difficult job without the expertise of pharmacists who understand the unique needs of those patients.

"Our MCO partners are often really well versed in the adult patient population and chronic diseases that afflict their adult patients — but sometimes the pediatric population's chronic conditions are different," Brigid Groves, a clinical pharmacist specializing in population health at Columbus-based Nationwide Children's Hospital, tells AIS Health.
 
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Topics: Specialty, Market Access, Provider, Payer

Trends That Matter for Hepatitis C Drugs

Posted by Leslie Small on Aug 29, 2019

Beginning last month, Louisiana has been able to treat hundreds of patients who were waiting to receive a pricey cure for hepatitis C thanks to after hammering out an innovative payment model with a drug manufacturer, AIS Health reported.

But the road to get there was long and difficult, according to Rebekah Gee, M.D., secretary of the Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings Institution, detailed the challenges she faced in trying to get a costly curative therapy to more people while facing down a $2 billion budget deficit. "We were told 'No' at least 50 times from a variety of people, whether it was the industry, or policymakers or individuals at the CDC…because it had never been done before," she said.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Large Employers Are Concerned About Million-Dollar Treatments

Posted by Leslie Small on Aug 27, 2019

For large, self-insured U.S. employers, their No. 1 concern related to pharmacy benefits is how to finance treatments that come with seven-figure price tags.

That's one finding of the National Business Group on Health (NBGH) 2020 Large Employers' Health Care Strategy and Plan Design Survey, AIS Health reported. Among the 147 employer respondents, 86% said they were either concerned or very concerned about "the impact of million-dollar treatments getting approved by the FDA."
 
Read More

Topics: Specialty, Market Access, Provider, Payer