TRP_1170x120_3-8-19

Medicaid

CVS says managed care model can save millions

CVS says managed care model can save millions

WOONSOCKET, R.I .— New research from CVS Health shows that state Medicaid programs that use a Managed Care Organization (MCO) and a contracted pharmacy benefit manager (PBM) to administer prescription drug coverage have significantly lower overall drug costs than those states that manage their own formulary. Further, researchers found that when states switched to managing

Law Has Rx Implications

Law Has Rx Implications

Routine monitoring of medication adherence is one of the Medicaid programs that must be included under a new law passed by Congress in response to the opioid epidemic. The recently passed opioid legislation makes improvements in treatment capacity for Medicaid patients. However, the legislation has significance for the pharmacy industry because it directs the Department

Work requirements may come to Medicaid

WASHINGTON — The Trump administration has issued guidance that opens the door to work requirements for Medicaid recipients, a major change in the 50-year-old program offering a safety net for Americans living in or near ­poverty. The White House touted the move for Medicaid work requirements as “making a positive and lasting difference” in the

What the Trump administration portends for pharmacy

What the Trump administration portends for pharmacy

The January 20, 2017, inauguration of President Trump as the nation’s 45th president is certain to bring with it changes in the health care environment, which may impact pharmacy in a variety of ways. As important as the new administration, however, is the fact that a “unified” government will take over in Washington, with Republicans

Pharmacy groups make case for pro-patient approach

WASHINGTON — Four pharmacy organizations, including the National Association of Chain Drug Stores, have asked the incoming White House administration and congressional leaders to maintain Medicare and Medicaid beneficiaries’ pharmacy access. “Policies that reduce local pharmacy access lead to poorer health outcomes, ultimately resulting in increased future health care costs,” the associations wrote to President-elect

CMS’ Medicaid managed care final rule addresses access

CMS’ Medicaid managed care final rule addresses access

ARLINGTON, Va. – The National Association of Chain Drug Stores hailed the Center for Medicare & Medicaid Services’ inclusion of network adequacy standards in the Medicaid and CHIP Managed Care final rule. NACDS said Wednesday that the final rule, released on April 21, would improve patient access to care in Medicaid and the Children’s Health

Administration keeps tinkering with ACA

Administration keeps tinkering with ACA

WASHINGTON — The Obama administration continues to alter the Affordable Care Act and propose changes to Medicaid funding as it seeks to increase the number of Americans who have health insurance and slow the pace of medical cost ­inflation. In a nudge to get more healthy people into the insurance pool, the government increased the

AMP issue illustrates the pressure on Rx

AMP issue illustrates the pressure on Rx

After years of political and legal wrangling, the Centers for Medicare & Medicaid Services (CMS) has issued its final rule on Covered Outpatient Drugs, which governs reimbursement to retail pharmacies for generic medications dispensed under Medicaid. The history of the regulation goes all the way back to the Deficit Reduction Act of 2005 (DRA), which

Health care spending outpaces economy

Health care spending outpaces economy

WASHINGTON — Health care spending in the United States last year exceeded $3 trillion as five years of slow growth was replaced by the Affordable Care Act’s expansion of Medicaid and private health insurance coverage. Prescription drug prices accelerated as well. Health care spending grew faster than the economy in 2014, and the federal share

Enrollment on health exchanges to grow slowly

Enrollment on health exchanges to grow slowly

WASHINGTON — Slow growth is foreseen for health insurance enrollment through the Affordable Care Act exchanges, the Obama administration said this month. Coverage by the end of 2016 will barely exceed current levels, the administration said. Sign-ups during the ACA’s upcoming open enrollment season will bring the number of covered individuals to 10 million, up

Uninsured rate continues to fall

WASHINGTON — Supporters of the Patient Protection and Affordable Care Act (ACA) hailed a recent Census Bureau report that the percentage of people without health insurance coverage declined by 2.9 percentage points last year, from 13.3% to 10.4%. That’s a reduction of 8.8 million people, the biggest one-year decline ever, and part of the reason

Proper use of Rxs cuts other health care costs

ARLINGTON, Va. — An examination of data on more than 1.5 million Medicaid enrollees found that when prescription drugs are taken appropriately as prescribed by a physician there is a reduction of other medical costs for certain Medicaid populations. The research, undertaken to examine the impact of changes in prescription drug use on medical costs,

Rising health care costs still a challenge

Rising health care costs still a challenge

WASHINGTON — Total U.S. health care spending growth is expected to average 5.8% in aggregate over the 2014-2024 period, according to a report published in Health Affairs and written by members of the Centers for Medicare & Medicaid Services’ Office of the Actuary. The authors note that this rate of growth is still substantially lower

Rx seeks a bigger role in Medicaid, Medicare

WASHINGTON ­— Medicare and Medicaid recently passed the half-century mark, and the National Association of Chain Drug Stores envisions an enhanced role for pharmacists in both programs, particularly Medicaid. Congress, too, is looking for opportunities to strengthen and sustain Medicaid. Last month the House Energy and Commerce subcommittee on health held a hearing titled “Med­icaid