Iowa Hospital Association’s Post

As the pharmaceutical landscape changes, plan sponsors face the challenge of ensuring stability and financial well-being for their beneficiaries. It’s important to carefully review any new or changing contract language around rebate adjustments and ask your PBM what implications will occur from the AMP cap removal. SlateRx is committed to alignment of incentives above all else ✅ We deliver complete protection against these changes, including price index guarantees, the preservation of rebate language, and maintenance of the optimal formulary strategy. ⚡ We encourage you to ask questions. Contact us to learn more! 💡 #stabiliy #transparency #empowerment

I was looking at a list of high cost claimants, and one drug has really peaked my interest - it costs roughly $125,000+ per year... Here are some things I learned - It seems to be increasing quickly in several populations (commercial and Medicare). You can see Medicare using this public data set through 2021... https://lnkd.in/gP35Yv-G MAVENCLAD - Also, such a well-named product; the name that certainly suggests improving health through protecting cognition (the drug treats MS). The history of the drug is fascinating - First went to market in 1993 for a different disease - https://lnkd.in/gcwVd9hp Applied to USA in 2010 and withdrew. Applied again in 2018/2019, and received approval. https://lnkd.in/g-_U74zm Steady increase in utilization from 2019 to present. I can imagine for patients suffering from MS who didn't respond to other treatments, this has been quite the long journey.

In January 2024, the cap on rebates paid in Medicaid plans was lifted, meaning all of a sudden manufacturers could have to pay more in rebates than the full price they collect on a drug.   Our latest article delves into the downstream implications of this policy change—such as on the Commercial market.     We provide details of the impact, suggestions for plan sponsors on what to look for, and emphasize the growing need for innovative solutions to protect plan sponsors from market events such as this. Click through our summary below or read the full article here: https://lnkd.in/evzTu_Cb

Just emailed CMS Part-d division about current situation with respect to pharmacy access issues, issues with patient harm and confusion, or issues with patient steering. Below was their response. My question: -If Centers for Medicare & Medicaid Services cannot directly intervene in disputes related to part D plans' reimbursement, than who's door we knock? -And why is CMS allowing such Antitrust practices to continue with respect to patient steering (directly related to reimbursement) and patient harm? -How many emails/votes CMS needs to collect data and not do anything about this raging unfair practice across the entire United States ? **(Pretty sure they have couple thousand complains already) Centers for Medicare & Medicaid Services, Federal Trade Commission please realize the above issues are Level 1 threat (Red zone) to NATION WIDE community pharmacies especially independents which is directly related to patient access and harm issues. We need immediate action now and NOT assuring answers at this point. National Community Pharmacists Association (NCPA) Ohio Pharmacists Association Thoughts or comments ?

United Healthcare EFF: 1/1/2024 Medicare Part B step therapy list of drugs United Healthcare has updated their Medicare Part B Drug Step Therapy Program for 2024. It states "Refer to the Medicare: Part B step therapy prior authorization requirements notice in the October 2023 Network Bulletin for further information. ALSO, United Healthcare Policy #  IAP.001.16  is titled "Medicare Part B Step Therapy Program" gives the EXCLUSIONS for step therapy! Very important link: https://lnkd.in/gindNT_j NOTE: This is for your basic Medicare Advantage Plans. If the patient has a Commercial Retirement Plan MANAGED by UHC, many do not require step therapy. Very important to do a "Product Specific Benefit Investigation". Message me for more details. #unitedhealthcare #healthinsurance #medicare #medicareadvantage #steptherapy #exclusion #revenuecyclemanagement #revenuecycle #revenuemanagement #revenue #frm #billingandcoding #medicalcoder #medicalbilling #medicalcoding #claimsmanagement #patientadvocacy #patientadvocacy #patientaccess #patientadvocate #patientcare #valuebasedcare

Medicare open enrollment is now. Our webinar from last year can help answer many questions you might have during this period. #RIA #medicare

What You Must Know About the Different Parts of Medicare

A bipartisan group of six senators released a discussion draft bill that aims to address a range of #340B issues, including community and specialty pharmacy access, child site eligibility, patient definition, and more. We thank these lawmakers for their leadership, especially on the devastating 340B pharmacy restrictions by drug manufacturers. We believe any legislative updates to 340B must protect health care access for patients who rely on the health care safety net. We are analyzing the draft and look forward to providing our updated recommendations to the senators. Our statement: https://bit.ly/48767J0 #Protect340B

Medicare's open enrollment period takes place this year from October 15 through December 7. This is the time to make changes to your prescription drug plan or health plan for coverage beginning January 1, 2024. Watch our webinar replay to learn which Medicare options might be best for you. https://lnkd.in/eNFHk9qc   #medicareopennerollment, #financialplanning, #wealthmanagement  

Is your current wound therapy covered by all Medicare Advantage plans? With over half of all covered Medicare lives being Advantage plans (and growing), it is imperative that these patients get access to the newest cutting edge, high efficacy therapies. Aurix is covered by Medicare and Medicare Advantage under a National Coverage Determination.