Pharmacy transparency: a rising trend in the industry
After publishing my Nov. 29 blog, which delved into Cost Plus Drugs’ expansion into the specialty drug market, CVS Health revealed plans to streamline its pricing and sales approach for pharmaceuticals in retail pharmacies. This move by the pharmacy giant, which operates approximately 9,500 retail pharmacies, involves simplifying the reimbursement process for these pharmacies. The…
Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect
Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…
Healthcare News of Note: 45% of consumers have at least 1 health-related social need
Over the past few weeks, I have found these recent industry news stories that should be of interest to healthcare finance professionals. 1. 45% of consumers surveyed have at least 1 health-related social need, says McKinsey & Company Forty-five percent of consumers report experiencing at least one health-related social need (HRSN), such as food insecurity,…
Cost Plus Drugs announces its expansion into specialty drugs
If you have ever attended one of my lectures over the past three years, it is very rare that I don’t at least mention Cost Plus Drugs and the impact they have made in the pharmaceutical sales industry. The latest news on Cost Plus Drug Company Just this week, Mark Cuban, the founder of Cost…
Congress doesn’t seem to be mulling a fix for the 2024 Medicare physician payment cut
Congress has mitigated a scheduled Medicare payment cut for physicians going into each of the last three years, but relief does not appear to be on the way for a fourth year running. Medicare’s 2024 final rule for physician payments includes a $1.15 decrease to the conversion factor, amounting to a reduction of more than…
Proposed rule sets Medicare penalties for providers that commit information-blocking infractions
Hospitals and other healthcare providers would face penalties for knowingly engaging in information blocking, with the sanctions affecting their Medicare reimbursement, according to a proposed rule from the U.S. Department of Health and Human Services (HHS) and CMS. Published at the beginning of November, the rule implements some terms of the 21st Century Cures Act,…
Healthcare News of Note: The Leapfrog Hospital Safety Grade shows hospitals ‘significantly’ reduced 3 hospital-acquired infections post-pandemic
Over the past few weeks, I have found these recent industry news stories that should be of interest to healthcare finance professionals. 1. Healthcare-acquired infection scores improve for hospitals, but patient experience scores continue to decline, says new Leapfrog report Although hospitals are doing better when it comes to reducing healthcare-acquired infections (HAIs) “after significant…
Senate bill would give hospitals a big break from looming Medicaid disproportionate share hospital cuts (updated)
Nov. 15 update: On Nov. 14, the House passed legislation on a bipartisan basis to keep the government funded through Jan. 19. Medicaid disproportionate share hospital payments would be guaranteed to remain at their full amount through that date, and the bill similarly maintains short-term funding for graduate medical education, community health centers and the…
CMS finalizes enhanced hospital price transparency requirements for 2024
Hospital price transparency mandates are set to become more stringent in the coming year as CMS seeks to strengthen regulations that have been on the books since 2021. Medicare’s 2024 final rule for hospital outpatient payments includes updates to the price transparency rules. Hospitals will need to post charge information using a more precise template,…
CMS’s 340B-acquired drug payment policy final rule is here
The 340B Drug Pricing Program final rule was published[DF1] [SS2] [SS3] in the Federal Register Nov. 8, 2023, after CMS released details of it (CMS-1793-F) on Nov. 2, 2023. The rule details the agency’s actions, and in some cases non-actions, to adjust Medicare payment rates for drugs acquired under the 340B program from calendar year 2018 through Sept.…