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Pharmacy Benefit Management Of Opioid Prescribing: The Role Of Employers And Insurers

In the last two decades, prescribing rates for opioids have increased nearly three-fold, from 76 million prescriptions in 1991 to approximately 207 million prescriptions in 2013.  This remarkable volume of opioid prescribing is unique to the United States, where 2015 prescribing amounts were...

ACA Round-Up: Bipartisan Market Stabilization Efforts Stall; Iowa 1332 Waiver Application Advances; And More

Talks on individual market stabilization measures collapsed as GOP leaders focus on the Graham-Cassidy legislation. CMS has preliminarily declared Iowa’s application for a 1332 state innovation waiver complete, opening a comment period on the most far-reaching such waiver application to date.

Non-Emergency Medical Transportation: Will Reshaping Medicaid Sacrifice An Important Benefit?

One non-medical service---transportation to medical appointments---has been part of Medicaid since its inception in 1966 and addresses one of the socioeconomic disadvantages that prevent Medicaid beneficiaries from accessing health services.

September 20, 2017 | Medicaid and CHIP, Population Health, Quality

Making Measurement Count: The Importance of NQF

At a time when the specialty societies are delving deeper into measure development and need NQF’s expertise and technical assistance more than ever, NQF’s future is in jeopardy. Unless Congress acts, the annually authorized mandatory $30 million invested in the nation’s quality measurement work...

Premiums For Employer-Sponsored Family Health Coverage Rise Slowly For Sixth Straight Year

In 2017, some 151 million Americans rely on employer-sponsored coverage. Annual family premiums for employer coverage rose an average of 3 percent to $18,764 this year. Workers’ average contribution to family premiums has increased more rapidly than the employer’s share since 2012 (32% vs. 14%).

What We Talk About When We Talk About Single Payer

A single-payer health care system in the United States could eliminate the private health insurance system as we know it, squeeze costs out of the system by reducing administrative expenses and instituting global budgets, and provide universal coverage, while at the same time maintaining the...

To Foster Information Exchange, Revise HIPAA and HITECH

Congress should learn a lesson from the success of banking industry and revise HIPAA and HITECH to allow providers and EHR vendors to charge fees for exchange of medical data.

Caution Warranted As VA Incorporates ICER Value Assessments Into Formulary Management Process

The Department of Veterans Affairs Pharmacy Benefits Management Services and the Institute for Clinical and Economic Review (ICER) recently announced a collaboration in which the VA will use the ICER’s drug assessments as part of its formulary development and price negotiations.

CBO Sees Slow Growth For Exchanges; Administration Promotes Agents And Brokers In Marketplaces

CBO has issued a report on federal health coverage subsidies for those under 65 in the next decade. And slides at the REGTAP.info site outline measures to increase the role of agents and brokers in the exchanges, but lack of insurer payment for Marketplace enrollments may stand in the way.

September 15, 2017 | Following the ACA, Insurance and Coverage

Private Employers Should Demand And Share Evidence From Payment Reforms

There is a dearth of evidence on the impact of payment reforms within employer health plans. However, employers can play a role in generating and sharing the evidence that they seek.

September 15, 2017 | Costs and Spending, Payment Policy