Healthcare News of Note: Medicare to negotiate reduced prices for 40 drugs by 2028, says study
- Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states.
- The answer rate for the 988 national suicide prevention and crisis hotline increased alongside surges in outreach volume, and people spent less time waiting to speak with a counselor in December 2022 when compared to the previous year.
- The specialties that made the most efficient use of telehealth visits were genetics and nutrition with in-person follow-up care required 4% and 10%, respectively, during the 90 days after the telehealth visit.
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.
1. Study predicts which 40 drugs Medicare will negotiate reduced prices for by 2028
“By 2028, Medicare will negotiate prices for 38 drugs dispensed in pharmacies and 2 drugs provided in physician offices,” wrote the authors of a study published in the Journal of Managed Care & Specialty Pharmacy in March. The drugs when combined … “accounted for $67.4 billion in gross Medicare spending in 2020.”
Benefits of prescription drug price negotiations
The study authors concluded: “Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states. By generating the list of drugs likely subject to Medicare negotiation in the initial years, we hope to provider researchers, policymakers, prescribers, and patient advocates with expectations on which drugs are expected to see reductions in beneficiary cost sharing.”
Seven inhalers, eight antidiabetics, five kinase inhibitors and three oral anticoagulants are the Part D drugs eligible for negotiation in 2026-28, according to the study.
“For 2028, Part B drugs will become eligible for negotiation,” wrote the authors. “However, only two Part B products are projected to be subject to negotiation, Keytruda [pembrolizumab] and Opdivo [nivolumab].
Impetus for negotiations
In an October 2022 hfm magazine column, Ken Perez, vice president of healthcare policy and government affairs, Omnicell, Inc., wrote: “Medicare negotiation is the centerpiece of the [Inflation Reduction Act]’s drug pricing reforms. “In simple terms, the law allows Medicare to essentially dictate the prices it will pay for many single-source branded drugs that account for the highest total expenditures for Medicare.
Starting in 2023, Medicare will negotiate directly with drugmakers to set the maximum fair price (MFP) for certain prescription drugs, with application of the negotiated prices starting in 2026. …”
Insulin price cuts announced
In other prescription drug-related news:
- On March 1, Eli Lilly announced “price reductions of 70% for its most commonly prescribed insulins and an expansion of its Insulin Value Program that caps patient out-of-pocket costs at $35 or less per month,” cutting the list price of its nonbranded insulin to $25 a vial as of May 1, and other insulin product price decreases as well.
- In mid-March, global healthcare companies Novo Nordisk Inc. and Sanofi announced they would lower certain insulin product prices effective Jan. 1, 2024.
2. The 988 national crisis hotline sees an increase of 43% in overall outreach December 2022 compared with previous year, says KFF
“Outreach to the new 988 number for the national suicide prevention and crisis hotline increased after its implementation in mid-July, then steadied until December 2022, when it rose again,” according to a KFF analysis reported Feb. 28.
The analysis showed that comparing December 2022 data to a year prior revealed:
- The combined number of calls, texts, and chats increased by 43% (371,655 overall outreach compared with 260,095).
- The number of texts increased more than eight-fold for a total of 59,484 but continued to be a small share of overall outreach.
- Chat volume “decreased slightly” (about 8%) to 70,616 in December 2022 compared with the year prior at 76,845 “possibly because text communication is preferred over chat.”
“The answer rate for 988 increased alongside surges in outreach volume, and people spent less time waiting to speak with a counselor,” wrote the study authors. In fact, “the average wait time for all methods combined decreased from 2 minutes and 52 seconds to 44 seconds.”
The June 21 edition of this blog discussed state and local preparedness for the hotline’s launch, and on Nov. 1 it reported: “28% more people used the new national 988 crisis line in its launch month.”
3. Most telehealth visits do not require an in-person follow-up, study shows
After reviewing more than 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022, a study by Epic Research showed “high follow-up rates were present only in specialties that unavoidably require regular visits with an in-person component for hands-on care, such as obstetrics and surgery.”
The specialties that made the most efficient use of telehealth visits were genetics and nutrition with in-person follow-up care required 4% and 10%, respectively, during the 90 days after the telehealth visit.
The study also showed that within three months of a telehealth visit:
- In nearly every specialty studied, most patients who had a telehealth visit did not require an in-person follow-up appointment in that specialty.
- For specialties that required follow-up, such as obstetrics and geriatrics, the additional visits were likely related to needing additional care, not duplicative care.
- Mental health and psychiatry had some of the lowest rates (15%) of needing in-person follow-up.
HFMA bonus content
- Listen to the Voices in Healthcare Finance podcast episode “The blame game in the media regarding patient financial conversations,” with host Erika Grotto. In this episode, HFMA Chief Content Executive Brad Dennison discusses the March hfm cover story about patient-friendly payment and what some media organizations get wrong.
- Read “New guidance for No Surprises Act arbitration looks like a boost for providers,” by Nick Hut, HFMA senior editor.
- Learn about HFMA’s two new leadership courses, which are based on feedback from members.
- Read the March issue of hfm magazine, including the feature “Monument Health revamps its revenue cycle leadership structure for the benefit of patients and the organization” by Nick Hut, senior editor, and the Expert Reviewed piece “Hospitals require an integrated team approach to ensuring revenue integrity” by Dawn Crump, MA, CHC, LSSBB, with MRO Corporation.