Healthcare Financial News

President Obama announced on Saturday that pharmaceutical and biotechnology companies have agreed to discount the cost of prescription drugs to Medicare beneficiaries who incur large out-of-pocket expenses when they fall in the “doughnut hole” coverage gap in Medicare Part D plans. The agreement, which Obama said will be included in the healthcare reform legislation he expects to sign in October, is part “of the landmark pledge many health industry leaders made to me last month when they offered to do their part to reduce health spending $2 trillion over the next decade,” he said in a statement.

Pharmaceutical companies said they will provide a 50-percent discount to most beneficiaries on brand-name medicines covered by a patient’s Part D plan when purchased in the coverage gap, and the negotiated price will be applied toward beneficiaries’ out-of-pocket costs. “Importantly, the proposal would not require any additional paperwork on the part of the beneficiary nor would an asset test be used for eligibility,” said a statement from the Pharmaceutical Research and Manufacturers of America. The drug discount will cost drug makers $80 billion in revenues over 10 years, reports the Wall Street Journal/Associated Press.

HHS announced yesterday that $6 billion in new federal funds will be made available to states and U.S. territories for the Children’s Health Insurance Programs (CHIP) for fiscal year 2009. The new funds were made available by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which was signed into law by President Barack Obama on February 4. Of the $6 billion in new funding under CHIPRA, HHS has released more than $1 billion and expects to allocate the remainder to the states and territories by the end of September. CHIPRA provides additional funding that will help states and territories maintain existing CHIP enrollment and expand their programs. In addition to increased funding, CHIPRA revised the annual allotment formula to better reflect projected state and program spending and extended CHIP through fiscal year 2013.

Read the press release.

A group of healthcare providers, technology companies, and diagnostic imaging organizations has joined forces to form the Imaging e-ordering Coalition. The coalition’s mission is to advance the use of electronic decision-support technologies that will guide clinicians in ordering diagnostic imaging tests. It also seeks to educate policy makers and healthcare providers about the patient-centered efficiencies of e-ordering and to recommend to lawmakers that they include e-ordering along with e-prescribing in developing incentives for making the healthcare system more efficient.

According to the coalition, e-ordering prevents some of the issues associated with a radiology benefit manager (RBM) model, in which healthcare insurers employ organizations to manage utilization and costs of certain diagnostic exams.  Issues associated with RBMs include regulatory oversight and the burden of physicians having to seek approval before ordering an imaging service. The prior-authorization requirement often denies patients the imaging studies their physicians believe are warranted. Patients are then steered toward lower-precision tests or they are forced to wait days or weeks to receive imaging services, says the coalition. E-ordering provides physicians with real-time electronic access to decisions that are linked to published, evidence-based clinical studies and are tailored to a patient’s specific circumstances.

Members of the coalition include the American College of Radiology, Center for Diagnostic Imaging, GE Healthcare, Medicalis, Merge Healthcare, and Nuance Communications, Inc.

Read the press release.