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Pharmacy/Prescription Drugs



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2020 Large Employers' Health Care Strategy and Plan Design Survey: Full Report
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions to provide insight into large employers' views on the rapidly changing health care landscape. Large employers were asked about their evolving role in bringing about change in health care, their thoughts about proposed policy changes and the position of virtual solutions in their offerings.
Aug 13, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Pharmacy Costs and Strategies
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions focused on solutions to high-cost therapies and other specialty medications. In addition, employers were asked about copay assistance programs and point-of-sale rebate programs.
Aug 13, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Policy
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions focused on employers' perspectives on Medicare for All and Medicare Expansion solutions. Employers were also asked what role the government could play around high-cost therapies.
Aug 13, 2019
Results from the 2020 Large Employers' Health Care Strategy and Plan Design Survey: Press Briefing
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions to provide insight into large employers' views on the rapidly changing health care landscape. The press briefing covered 10 key insights into how large employers are approaching the delivery system, policy, pharmacy, health care cost management and more.
Aug 13, 2019
Joint Letter to Congress Supporting Passage of the Lower Health Care Costs Act (S. 1895)
The Business Group, in conjunction with other employer groups, sent a letter to all Members of Congress urging them to pass the Lower Health Care Costs Act (S. 1895) that would end the surprise billing crisis via local, market-based benchmark payments, reduce the high prices of prescription drugs, increase transparency and competition, fund America's health care
Aug 7, 2019
CMS Rule Finalizes Some Medicare Drug Policy Changes, Withdraws Others
Last month, CMS issued final prescription drug rules for Medicare Advantage (Part C) and Prescription Drug (Part D) plans for 2020 that will permit Part C plans to implement step therapy protocols for specialty drugs but declined to finalize rules permitting Part D plans to exclude drugs from formularies in Medicare's protected classes under specific circumstances.
Jun 4, 2019
What Your CEO is Reading - Zolgensma: A New High for Drug Therapies at $2.12M
What Your CEO is Reading - Zolgensma: A New High for Drug Therapies at $2.12M.
May 29, 2019
What Your CEO is Reading - Potential Impact of Alleged Generic Price Fixing
Last week, media scrutiny of the generic pharmaceutical industry erupted following the May 10, 2019 public release of a 44-state lawsuit led by the state of Connecticut. Context for the suit was characterized by a 60 Minutes segment as the "biggest price fixing scheme in the history of the United States." The story was also picked up by the Washington Post, NPR, New York Times, and Reuters, among others.
May 22, 2019
Joint Letter to the FDA Expressing Concern with Draft Guidance on Naming Biologics
The National Business Group on Health sent a joint letter to the FDA expressing concern with draft guidance on naming biological products that could harm the development of a robust biosimilars market in the United States, putting access and savings for patients in jeopardy.
May 7, 2019
Letter to Representatives Schrader (D-OR) and Carter (R-GA) Supporting Passage of the BLOCKING Act of 2019
The National Business Group on Health (Business Group) writes in strong support of the bipartisan bill (H.R. 938 - BLOCKING Act of 2019) that would amend the Federal Food, Drug, and Cosmetic Act to prevent first-to-file (FTF) generic prescription drug manufacturers from blocking competition by other manufacturers.
May 2, 2019
ACA Update: Out-of-Pocket Maximums & Prescription Drug Coupons
Recently, the Department of Health and Human Services (HHS) issued its annual regulatory update for public Exchanges and other ACA requirements. These regulations include several new developments on the OOPM and drug coupons for employer-sponsored group health plans.
May 1, 2019
Letter in Support of Bipartisan Senate Bill to Prohibit Anticompetitive Prescription Drug Pay-for-Delay Deals
The National Business Group on Health sent a letter of support to Senators Charles Grassley and Amy Klobuchar for their bill (S 64), which would ban anticompetitive deals between pharmaceutical companies to delay entrance of competitor drugs to the market.
Apr 23, 2019
Comments to HHS' Rebate Proposal Applauding Efforts to Change Medicare Policy, But Expressing Serious Concerns with the Existing Proposal
The National Business Group on Health sent comments to HHS Inspector Daniel R. Levinson supporting changes in Medicare policy impacting how drugs are priced at the pharmacy counter, but expressing serious concerns with the proposal including 1) a weighted focus on out-of-pocket (OOP) costs; 2) the potential to increase list prices by passively incenting price collusion; 3) the potential to increase list prices by failing to address antitrust law; 4) a financial windfall to manufacturers; 5) a disincentive for the promulgation of value and/or risk-based payment models; 6) an unworkable implementation timeline; and 7) an increase in beneficiary premiums.
Apr 10, 2019
Joint Comments to HHS Opposing a Proposed Rule to Eliminate Rebates in Medicare while Supporting Efforts to Curb the High Prices of Prescription Drugs
The Business Group, joined by providers, pharmacists and other interested parties, sent joint comments to HHS Inspector Daniel R. Levinson opposing a proposed rule that would eliminate rebates in Medicare that could jeopardize the high-quality, affordable prescription drug coverage provided in Medicare Advantage, including employer group waiver plans (EGWPs) and integrated Medicare Advantage Prescription Drug plans, and cause unintended consequences to beneficiaries.
Apr 8, 2019
House Education and Labor Subcommittee Holds Hearing on Surprise Medical Bills
On Tuesday, the U.S. House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions held a hearing on surprise medical bills, the first in the House.
Apr 5, 2019
House Energy and Commerce Committee Passes 6 Bills Aimed at Increasing Generic Drug Competition
On Wednesday, after reaching bipartisan consensus, the U.S. House Energy and Commerce Committee passed the following 6 bills to boost generics.
Apr 5, 2019
Testimony to the U.S. Senate Committee on Finance with Recommendations to Promote More Affordable, Financially Sustainable Prescription Drug Pricing
In response to a Senate Finance Committee hearing on prescription drug pricing on February 26th, the Business Group sent testimony with specific recommendations promoting affordable, financially sustainable prescription drug pricing highlighting our Public Policy Brief's recommendations.
Mar 12, 2019
Senate Finance Committee Spars with Pharmaceutical CEOs at Hearing
The next installment of Congress' ongoing focus on prescription drug price increases featured Senators from both sides of the aisle firing a barrage of criticism and questions at CEOs from seven leading manufacturers during last Wednesday's Senate Finance Committee (SFC) hearing.
Mar 4, 2019
Letter to Senate HELP Chair Lamar Alexander (R-TN) with Recommendations to Slow Rising Health Costs and Improve Health Outcomes
The National Business Group on Health sent a letter in response to Senate HELP Committee Chair Alexander's request for information on specific recommendations for Congress and the Administration to slow rising health care costs, improve health outcomes and increase access to information to make informed decisions about health care. Specifically, the Business Group recommended eliminating the ACA's Cadillac Tax, ending surprise billing, supporting HSA-qualified health plan improvements, advancing policies to promote more affordable, financially sustainable prescription drug prices, encouraging and promoting transparency and accelerating payment and delivery reform in Medicare/Medicaid.
Mar 1, 2019
House Ways and Means Committee Holds Hearing on Reducing Prescription Drug Prices
On Tuesday, the House Ways and Means Committee held a hearing on proposals to reduce prescription drug prices following House and Senate Committee hearings in late January.
Feb 15, 2019
Congress Holds Hearings on Prescription Drug Price Increases
In its first week since the government reopened, Congress addressed prescription drug price increases with the House Committee on Oversight and Reform and the Senate Finance Committee holding hearings on Tuesday.
Jan 31, 2019
New Year, New Congress, New Health Policy? The Outlook in Washington for 2019
As the House changes hands, the Administration sets its agenda, and a federal court decision once again finds the ACA unconstitutional tune in hear what we expect for the health policy agenda in 2019.
Jan 30, 2019
As Prescription Drug Makers Raise Prices, President Trump Huddles with Advisers
Last week, President Trump met with key Administration officials, including HHS Secretary Alex Azar, to express frustration with news reports that list prices for 250 medicines have increased by an average of 6.3% and plan the Administration's moves.
Jan 14, 2019
Senators Grassley (R) and Klobuchar (D) Introduce Drug Importation Bill from Canada
Senate Finance Committee Chairman Chuck Grassley (R-IA) and Senator Amy Klobuchar (D-MN) introduced a bill that would require the HHS Secretary to propose rules within 180 days of enactment that would permit individuals to import up to a 90 day supply of drugs from approved Canadian pharmacies, excluding controlled substances and specialty pharmacy medications.
Jan 14, 2019
Comments to CMS on the International Pricing Index Model for Medicare Part B Drugs Recommending Consideration of the Impact of Policy Changes on Employer Plans
The National Business Group on Health submitted comments to the CMS Administrator's advanced notice of proposed rulemaking on the International Pricing Index for Part B Drugs recommending that any changes to the Medicare policies don't shift costs to employer plans and that changes to "buy and bill" practices do not accelerate market consolidation and vertical integration of oncology and rheumatology practices.
Dec 31, 2018
CMS Administrator Suggests More Medicare Rx Formulary Flexibility to Lower Prescription Drug Prices
Last Wednesday, as part of a broader speech on the Trump Administration's efforts to reduce prescription drug prices, CMS Administrator Seema Verma suggested that Medicare Part D prescription drug plans be able to have more formulary flexibility.
Nov 20, 2018
House Win for Democrats Impacts Health Policy Agenda in Washington
As the results of the 2018 election are finalized, Democrats have regained control of the House, while the Senate will stay in Republican hands. Democrats highlighted health care as an issue in the election and will likely make it a priority on their agenda
Nov 8, 2018
President Trump Proposes to Base Pay for Medicare Part B Drugs on International Prices
Last week, President Trump announced that CMS' Center for Medicare & Medicaid Innovation would test new payment models for Part B drugs, biologics and biosimilars, which are typically specialty medications administered by physicians, that would more closely reflect prices paid by other high performing economies via an international pricing index.
Oct 31, 2018
Congress Passes Bill to Prohibit Pharmacy Gag Clauses and Increase Scrutiny of Biosimilar Pay-For-Delay Deals
On Tuesday, the House unanimously passed 2 Senate-approved bills that prohibit pharmacy gag clauses. The bills apply to all plans, including employer-sponsored plans
Sep 28, 2018
CMS to Permit Medicare Part D Plans to Adopt More Flexible Formularies
Late last month, CMS issued a memo indicating that by 2020 it will permit Medicare Part D plans to implement an indication-based formulary design..
Sep 7, 2018
CMS Will Permit Medicare Advantage Plans to Implement Step Therapy for Part B Drugs
Last week, CMS announced that as part of the President's American Patients First blueprint beginning January 1, 2019 Medicare Advantage could apply step-therapy protocols for Part B drugs, which are usually specialty medications administered by physicians.
Aug 17, 2018
What Your CEO Is Reading - Challenging Pharmaceutical Rebates
Media attention has continued focus on the dysfunction in the pharmaceutical supply chain model and its contribution to high and rising drug prices.
Aug 2, 2018
What Your CEO Is Reading - Drug Price Reduction Efforts
This WYCIR examines efforts by the Trump Administration to lower drug prices, and corresponding industry reaction.
Jul 25, 2018
Comments to HHS Secretary Alex Azar on the American Patients First Blueprint to Lower Drug prices and Reduce Out-of-Pocket Costs
The National Business Group on Health provided comments on the Administration's RFI on lowering drug prices by supporting improved competition, better negotiation and lower list prices, increased value-based contracting and innovative pricing/reimbursement mechanisms, and reduced patient out-of-pocket spending.
Jul 17, 2018
President Again Calls for Action to Control Prescription Drug Prices
Today, President Trump outlined his Administration's blueprint for tackling prescription drug prices.
May 11, 2018
Congress Holds Opioid Hearings; Plans to Pass Legislation this Spring
On April 11th and 12th, Congress held 5 hearings in the House and Senate examining policy proposals to combat the opioid epidemic.
Apr 13, 2018
Senate Bill Would Impose 3-Day Limit on Initial Opioid Scripts
A bipartisan group of Senators introduced a bill that would limit first prescriptions for opiods to 3 days.
Mar 5, 2018
New Spending Deal Kills Medicare Payment Advisory Board and Speeds Up Relief to Seniors for Out-of-Pocket Drug Costs
Last Friday, Congress passed and President Trump signed the Bipartisan Budget Act of 2018 which funds the federal government through March 23. The law also eliminates the ACA-created Medicare Independent Payment Advisory Board and closes the donut hole in 2019.
Feb 14, 2018
President's Budget Repeats Call to Lower Prescription Drug Prices
Monday, President Trump released his budget for FY 2019 again calling for lowering prescription drug prices
Feb 14, 2018
President Trump Reiterates His Intention to Tackle Prescription Drug Prices during State of the Union Address
During Tuesday night's State of the Union Address and at this Monday's swearing in of Alex Azar as HHS Secretary, President Trump emphasized the need to focus on reducing prescription drug prices among other priorities.
Feb 1, 2018
Comments to HHS Secretary Alex Azar on a Request for Information (RFI) on Promoting Healthcare Choice and Competition
The National Business Group on Health sent comments to HHS Secretary Alex Azar providing employer perspectives on consolidation in healthcare markets and abuses of market power, the need for improved consumer access to quality information and reforms to increase competition in the prescription drug market.
Jan 25, 2018
PhRMA Challenges California Drug Price Law in Federal Court
In early December, the Pharmaceutical Research and Manufacturer's Association (PhRMA) filed suit in the United States District Court for the Eastern District of California to block a California law that requires drug manufacturers to notify the state and justify high price increases.
Jan 11, 2018
NBGH Working for You in Washington
Details of NBGH Advocacy activity in the last month to advance employers' health policy agenda
Dec 19, 2017
2017 Response to the FTC's "Understanding Competition in Prescription Drug Markets: Entry and Supply Chain Dynamics" workshop on November 8, 2017
The Business group supports the FTC's efforts in taking a comprehensive look at the supply side of the prescription drug market, through the lens of the generic drug market, pharmaceutical intermediaries, and group purchasing organizations. Please open the letter for our specific policy recommendations.
Dec 8, 2017
Massachusetts Medicaid Drug Formulary Proposal Could Reduce Drug Price Pressure
Earlier this year, Massachusetts Health and Human Services Department filed a waiver with CMS to adopt a closed Medicaid prescription drug formulary.
Nov 21, 2017
2017 Response to CMS's Request for Information (RFI) for the Center for Medicare and Medicaid Innovation (CMMI)
The Business Group supports CMS's efforts to prioritize the goal of fostering an affordable, accessible healthcare system that puts patients first. We also strongly encourage the agency to stay the course on initiatives that are working well to reduce costs while improving quality, particularly alternative payment and delivery models. Open the letter for comprehensive policy recommendations.
Nov 20, 2017
What Your CEO is Reading: Opioid Public Health Emergency
President Donald Trump declared the nation's opioid crisis a "public health emergency," underscoring employer concerns with this growing epidemic.
Oct 26, 2017
Manufacturer Lawsuit Challenges Common Drug Industry
A recent lawsuit alleges that exclusionary contracting arrangements, including rebate terms, with insurers and PBMs amount to anticompetitive practices prohibited by antitrust law, and have served to inhibit biosimilar competition.
Sep 29, 2017
White House Commission Recommends Aggressive Enforcement of Mental Health Parity Rules to Combat Opioid Abuse
Last week, a White House Commission on Combating Drug Addiction and the Opioid Crisis released an interim report urging President Trump to declare opioid abuse a national emergency, thereby increasing the pressure on his cabinet to act and on Congress to increase funding to combat the epidemic.
Aug 9, 2017
An Overview: State and Federal Prescription Drug and Pharmacy Bills, Their Implications, and Likelihood of Passage
This webinar evaluates current and potential policy options proposed by both state and federal policy makers, discusses how these policy options may impact employers and employer pharmacy spending trends, and assesses the outlook for adoption of various policies.
Jul 20, 2017
Letter to the FDA Encouraging Innovation in Drug Development and Accelerating the Availability of Lower Cost Alternatives to Innovator Drugs
The National Business Group on Health sent a letter to FDA Commissioner Gottlieb commending the FDA for its work on the implementation of a successful pathway by which generic pharmaceuticals are brought to market. Additionally, we made recommendations to eliminate or limit additive patent extensions, discourage patent abuses, eliminate pay-for-delay deals and reduce market exclusivity periods.
Jul 18, 2017
Letter to the FDA's Oncologic Drugs Advisory Committee Supporting Approval of 2 Proposed Biosimilars
The National Business Group on Health submitted a letter to the FDA's Oncologic Drugs Advisory Committee supporting FDA approval of 2 biosimilars and a regulatory environment that favors the robust uptake of high quality, safe, and efficacious biosimilars.
Jul 13, 2017
Trump Administration May Issue Executive Order Soon on Drug Pricing, May Also Expand Exemption from HSA Plan Deductibles for Maintenance Medications
Recently, the NY Times reported that the Trump Administration is reportedly weighing issuing an executive order on drug pricing
Jul 3, 2017
Senate HELP Committee Holds Hearing on Prescription Drug Prices; Examines Broader Drug Exemption from HSA Deductible
On Tuesday, the Senate Health, Education, Labor & Pensions Committee held a hearing on reducing prescription drug prices.
Jun 15, 2017
Supreme Court Denies Additional 6 Month Exclusivity for Brand Biologics
On Tuesday, the Supreme Court unanimously overturned a lower court decision that effectively gave 6 additional months of market exclusivity to brand biologics on top of the 12 years guaranteed by law that bans competitor drugs in the market.
Jun 15, 2017
New FDA Commissioner Wants to Increase Generic Competition; Reduce Prescription Drug Prices
Last Thursday, the new FDA Commissioner, Scott Gottlieb, M.D. testified before the House Budget Committee that one of his priorities will be speeding up FDA approval of generic drugs in order to bring down prescription drug prices.
Jun 1, 2017
Supreme Court Hears Arguments on Delaying Competitor to Brand Biologic to Market
On Wednesday, the Supreme Court heard arguments on whether it should overturn a lower court ruling that effectively gives 6 additional months of market exclusivity to biologics on top of the guaranteed 12 years by requiring the FDA to approve a biosimilar before a generic manufacturer can satisfy the Biologics Price Competition and Innovation Act's notice of commercial marketing provision.
Apr 28, 2017
California and Colorado Voters Reject Health Ballot Initiatives
Last Tuesday, California and Colorado voters rejected health ballot initiatives that could have substantially impacted employer-sponsored coverage.
Nov 17, 2016
California and Colorado Health Initiatives on November 8th Ballot
As people vote on November 8th, California and Colorado voters will also decide on health ballot initiatives. In Colorado, voters will decide whether the state will apply for an ACA Innovation Waiver that would implement a universal health plan beginning January 2019. ). In California, voters will decide whether to require the state to pay prices for prescription drugs no higher than those paid by the U.S. Department of Veteran’s Affairs (up to 24% lower) for certain populations.
Oct 31, 2016
Clinton and HHS Secretary Call for Medicare Negotiation of Drug Prices
At a forum Thursday in Washington, HHS Secretary Burwell, when asked how the government should respond to the Epi-pen crisis, said that Medicare should have the ability to negotiate prices for high cost drugs and specialty pharmacy medications.
Sep 30, 2016
Congress Funds Government through December 9 and Approves Funds to Combat Zika and Opioid Abuse
This week, Congress struck a deal to fund the federal government until December 9, averting a shutdown October 1st. The funding deal also includes funding to combat zika and opioid abuse.
Sep 30, 2016
CMS Bows to Provider Pressure to Delay Performance Penalties
Recently, CMS, facing pressure from the provider community, proposed to allow providers to choose the extent to which they report quality performance data in 2017 to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Sep 22, 2016
National Business Group on Health’s Position Statement on Opioids
Policy makers should advance efforts to control prescription opioid abuse, which represent a substantial and growing economic and social burden.
Sep 7, 2016
Select Recent Examples of Publicly Disclosed U.S. Value-Based Pricing Arrangements
The chart contains recent examples of publicly disclosed value-based purchasing arrangements between pharmaceutical manufacturers and payers.
Sep 7, 2016
Comments to CMS Administrator Supporting Proposed Changes to Medicare Hospital Outpatient Reimbursements that Would Continue the Transition from Fee-for-Service towards Payment Models that Command Value and Efficiency
The National Business Group on Health sent a letter to Acting CMS Administrator Andy Slavitt supporting implementing site-neutral payments, removing pain management from dimension of the HCAHPS survey, and more.
Sep 6, 2016
Biologics Competition: An Update on the Market and Future Policy Actions
Understanding how public policy will impact employers ability to utilize biosimilar drugs in place of high price branded specialty/biologic drugs.
Jul 29, 2016
Comments to CMS Acting Administrator Slavitt Supporting a Proposed Rule that Would Move Medicare Away from Fee-for-Service
The National Business Group on Health recently submitted comments to CMS on a proposed rule implementing the Medicare Access & CHIP Reauthorization Act of 2015 supporting the proposed rule and urging CMS to sustain and amplify its commitment to transforming the payment for and delivery of care, and continue to streamline reporting, enhance quality of care, and implement policies to encourage cost-effectiveness.
Jun 27, 2016
House Passes Bill that Would Allow More Hospital-Owned Facilities to Charge Medicare More than Other Sites of Care for the Same Outpatient Services
Recently, the House passed a bill that would allow planned off-campus hospital outpatient departments (mid-build HOPDs) to continue to charge Medicare more for the same services delivered at other sites of care.
Jun 17, 2016
Ohio Moves Closer to Ballot Referendum to Cap Drug Prices for State Health Programs
Earlier this month, the OH Supreme Court allowed proponents of a ballot referendum (AIDS Healthcare Foundation) to go forward collecting signatures to require the state to pay prices for prescription drugs no higher than those paid by the U.S. Department of Veteran’s Affairs (V.A.) by July 1, 2017.
Jun 17, 2016
Letter to House Speaker Ryan Opposing Legislation that Would Weaken Medicare Site-Neutral Payments
In response to recently-passed legislation (H.R. 5273), the Business Group sent a letter to House Speaker Paul Ryan expressing concerns about exempting mid-build off-campus hospital outpatient departments (HOPD) from the site-neutral payment requirement in Section 603 of the Bipartisan Budget Act of 2015.
Jun 13, 2016
Chart - 2015-2016 State Pharmaceutical Cost/Price Reporting Bills
This chart tracks state legislative efforts to control the price of prescription drugs.
Jun 3, 2016
FDA Delays Rule Requiring Updating of Generic Drug Product Safety Labels
Recently, the FDA delayed a final rule (until April of 2017) that would require generic drug manufacturers to update product safety labels to warn consumers of newly- discovered risks.
May 31, 2016
Vermont to Require Rx Manufacturers to Report Reasons for High Price Increases for Certain Drugs
Recently, Vermont’s legislature passed a bill that would require pharmaceutical manufacturers to report to the state the reasons behind price increases for up to 15 drugs.
May 31, 2016
Comments to SAMHSA Supporting Removing Regulatory Burdens for Qualified Physicians to Treat Opioid Use Disorder
Recently, the National Business Group on Health sent comments to The Substance Abuse and Mental Health Services Administration (SAMHSA) recommending increasing the number of patients (from 100 to 200) that physicians can treat for opioid addiction.
May 18, 2016
Clinton Proposes Medicare Buy-In for People Aged 50 and Up
Clinton Proposes Medicare Buy-In for People Aged 50 and Up
May 13, 2016
FDA Drafts Guidance to Increase Safety of Compounded Drugs
Recently, the FDA released guidance for physicians, pharmacies, hospitals and facilities that supply compounded drugs (outsourcing facilities) to implement the Drug Quality and Security Act of 2013, which granted increased FDA oversight over drug compounding in response to a multistate outbreak of fungal meningitis.
May 13, 2016
Comments to CMS Supporting Testing Value-Based Payments for Outpatient Drugs and Expressing Concern with a Proposal that Could Lead to Increased Provider Consolidation
In response to a CMS proposed rule, the Business Group sent comments strongly supporting testing value-based payments for outpatient drugs. However, the Business Group also expressed concern with a different part of the rule that could have the unintended consequence of accelerating consolidation of non-hospital affiliated independent clinical oncologists that could lead to substantial spikes in prices.
May 9, 2016
New Coalition Unveils Proposals Aimed At Sustainable Pricing of Prescription Drugs
The Campaign for Sustainable Rx Pricing (comprised of consumer groups, hospital and physician groups, insurers, unions, and a large, national employer), a project of the National Coalition on Health Care, recently released a multi-pronged proposal recommending legal and regulatory reforms to promote sustainable pricing for prescription drugs, particularly high-priced new specialty pharmacy therapies.
May 2, 2016
Chart: State Biosimilar Substitution Laws
The chart tracks state laws making it harder for pharmacists to substitute biosimilar drugs for brand biologic medications.
Apr 7, 2016
Medicare Demonstration Project Will Test Value-Based Payments for Outpatient Drugs
Recently, CMS proposed a 5 year demonstration project that could change how Medicare pays for drugs administered in outpatient settings.
Mar 30, 2016
Comments to CMS on a Proposed Rule on the ACO Program Strongly Supporting Market Transitions Away from Fee-for-Service
The National Business Group on Health submitted comments to CMS Acting Administrator Andy Slavitt strongly supporting market transitions away from fee-for-service to those which place a focus on value-based payments, particularly accountable care arrangements that encourage care coordination and provider accountability for population health. We also support increased participation by ACOs in two-sided risk models and believe these arrangements are essential to improve patient care and reduce costs for unnecessary, wasteful and ineffective care.
Mar 28, 2016
Generic Rx Manufacturer Wants to Eliminate Additional 6 Month Biologic Exclusivity Period; Asks Supreme Court to Review
Recently, a generic drug manufacturer asked the Supreme Court to review a Circuit Court ruling that effectively gives 6 additional months of market exclusivity to biologics on top of the guaranteed 12 years.
Mar 15, 2016
Joint Letter to HHS Secretary Burwell Expressing Strong Opposition to 2017 Medicare Advantage Cuts
The National Business Group on Health sent a joint letter to HHS Secretary Burwell expressing strong opposition to the 2017 Medicare Advantage (MA) Advance Notice’s proposed change to the payment methodology for MA Retiree Coverage that will amount to a nearly 3% cut that puts at risk health care stability and access for over 3.3 million beneficiaries that are enrolled in MA Retiree Coverage.
Mar 15, 2016
Medicare Proposes Expanding Bundled Payments and Putting Hospitals at Risk for Joint Replacement
Expanding upon its voluntary bundled payment program for hip and knee replacement, CMS recently proposed a 5 year program that would require all hospitals in 75 selected areas to participate.
Jul 14, 2015
Comments to the Centers for Medicare and Medicaid Services (CMS) on the 2016 Proposed Rule for the Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals
The National Business Group on Health submitted comments to the Centers for Medicare and Medicaid Services’ (CMS) supporting their proposed Hospital Inpatient Prospective Payment Systems (IPPS) changes for acute care hospitals for 2016.
Jun 16, 2015
FDA under Pressure to Speed Drug Approvals and Okay Off-Label Use
Parts of a House bill designed to spur biomedical innovation would also streamline the FDA approval process for new drugs and reduce FDA restrictions on communications by manufacturers about off-label use of medications.
May 18, 2015
President Signs Law Changing the Way Medicare Pays Doctors
Last Thursday, President Obama signed a law that will replace the way Medicare pays physicians and will more firmly set Medicare on a path away from fee-for-service (FFS).
Apr 23, 2015
Little-Noticed Provision in Medicare Physician Payment Bill Would Allow More Access to Medicare Claims Data for Analytics
A bipartisan congressional agreement to change the way Medicare pays physicians contains a provision that would make it easier for insurers and employers to obtain analyses of Medicare claims data and for providers and suppliers to obtain Medicare claims data for analyses.
Mar 27, 2015
FDA Okays 1st Biosimilar but Caveats Could Limit Substitutability
Earlier this month, the FDA approved the first biosimilar medication to use the ‘fast track” pathway established by the ACA to speed up FDA approval of competitor drugs to biologics coming off patent.
Mar 19, 2015
House Leaders Plan Vote on Bipartisan Medicare Physician Payment Reform Next Week as Deadline Looms
As the deadline for a mandatory 21% cut in Medicare physician reimbursement looms at the end of the month, House Speaker John Boehner (R-OH), Minority Leader Nancy Pelosi (D-CA), and others in both the House and Senate are scrambling to agree on a bill that would permanently reform the way Medicare pays physicians.
Mar 19, 2015
Federal Court Invalidates Maine's Rx Importation Law
Recently, a federal judge in Maine struck down the state’s first-in-the-nation prescription drug importation law.
Mar 3, 2015
House Plans Hearing as Legal Fight over Hospital Drug Discount Program Continues
On March 5, the House Energy and Commerce Health Subcommittee will hold a hearing on a hospital drug discount program known as 340B.
Mar 3, 2015
HHS Issues Additional Regulations for Retiree Drug Subsidy Program
HHS has issued additional regulations on how employers should report payments to PBMs for purposes of the Retiree Drug Subsidy Program.
Jan 13, 2012
Comments to the Centers for Medicare and Medicaid Services (CMS) on the Medicare Shared Savings Program and Accountable Care Organizations (ACOs)
The National Business Group on Health submitted recommendations to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule implementing Section 3022 of the Patient Protection and Affordable Care Act (ACA) establishing the Medicare Shared Savings Program and Accountable Care Organizations (ACOs) to ensure ACOs truly deliver on the promise of better care and better health at lower costs.
Jun 6, 2011
New Medicare Part D Creditable Coverage Notice Requirements and OTC Drug Plan Amendment Deadline
Because the Patient Protection and Affordable Care Act (ACA) changed the Medicare Part D election period to October 15 - December 7, plan sponsors now, beginning in 2011, must provide notices of creditable and non-creditable coverage to Medicare-eligible individuals before October 15th each year. Also, the deadline for adopting Cafeteria Plan Amendments to prohibit reimbursement of over-the-counter drugs is June 30, 2011.
Jun 3, 2011
Medicare Prescription Drug Subsidy Guidance
Policy Alert - July 16, 2007
Jul 16, 2007
CMS Updates Guidance on Notices of Creditable and Non-Creditable Prescription Drug Coverage to Medicare Beneficiaries
Policy Alert - April 21, 2006
Apr 21, 2006
CMS Guidance Details How HRAs May Qualify for the Employer Subsidy under the Medicare Prescription Drug Benefit
CMS issued guidance on the treatment of health accounts 1) to qualify for the employer subsidy and 2) to calculate the beneficiary out-of-pocket limits for the catastrophic prescription drug benefit.
Jun 16, 2005
CMS Guidance Details How HRAs may Qualify for the Employer Subsidy under the Medicare Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) issues guidance on the treatment of health accounts 1) to qualify for the employer subsidy and 2) to calculate the beneficiary out-of-pocket limits for the catastrophic prescription drug benefit.
Jun 16, 2005
CMS Clarifies Actuarial Equivalence Calculation Rules for Employer Subsidy under Medicare Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) provides employers and retiree plan actuaries with more information on determining whether their retiree prescription drug benefits are at least as valuable as those provided under the Medicare prescription drug benefit.
Apr 13, 2005
CMS Issues Third Round of Guidance on Employer Waivers for Medicare Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) releases its third round of guidance on waivers for retiree prescription drug coverage which provides waivers for Medicare Part D bid submissions, group enrollment and other requirements for employer direct contract plans and group MA-PD and PDP Plans.
Apr 11, 2005
CMS Offers More Guidance on Employer Waivers for Medicare Prescription Drug Benefits
The Centers for Medicare and Medicaid Services (CMS) offers additional guidance on employer waivers which provide employers significant flexibility in choosing options for their retiree prescription drug programs.
Mar 14, 2005
CMS Guidance on Employer Waivers for Retiree Prescription Drug Coverage
The Centers for Medicare and Medicaid Services (CMS) released initial guidance on waivers for employer-sponsored retiree prescription drug coverage which focuses on an employer's option to provide customized retiree Part D coverage through an MA-PD (a Medicare Advantage plan covering prescription drugs) or PDP plan (a stand-alone prescription drug plan), or by contracting with CMS to become an MA-PD or PDP plan.
Feb 15, 2005
CMS Issues Rules for Implementing Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) issues final regulations for implementing the new Medicare prescription drug benefit which provides new details on determination of actuarial equivalence, employer subsidy and employer requirements regarding creditable coverage.
Jan 31, 2005
Final Guideline on Accounting and Disclosure Requirements for the New Medicare Law for Retiree Health Plans Released by the Federal Accounting Standards Board (FASB)
Policy Alert - June 3, 2004
Jun 3, 2004

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