CMS finalizes drug price transparency rule in MA, Part D | Most health insurance providers offer virtual care, AHIP reports | Report highlights factors hindering improvements in patient matching
May 17, 2019
AHIP Solutions SmartBrief
Top Stories
CMS finalizes drug price transparency rule in MA, Part D
The CMS issued a final rule that requires Medicare Advantage and Part D plans to offer a drug cost transparency tool that can be integrated into prescribers' EHRs and also requires Part D plans to share price transparency and low-cost alternative information in monthly letters to beneficiaries. The final rule also bans contract clauses that restrict pharmacist-patient conversations about drug prices, but it does not include measures requiring price concessions to be passed to consumers, nor does it include proposed changes to management of protected drug classes.
Patient Engagement HIT (5/16),  Modern Healthcare (tiered subscription model) (5/16) 
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Most health insurance providers offer virtual care, AHIP reports
A survey released by AHIP found most commercial, Medicare Advantage and managed Medicaid health insurance providers are already offering some type of virtual care, and they report benefits including improved health outcomes, increased patient satisfaction and better access to care. Most commercial and Medicaid managed care providers, however, said patient engagement remains a barrier to full adoption of virtual care.
Healthcare Dive (5/16) 
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Eliminate hidden costs of genetic testing claims
Genetic testing claims are often inappropriately paid, even when a health plan maintains an effective UM program. Learn four strategies to better identify tests and reduce unnecessary payments, from the nation's leading independent organization of genetics specialists.
Providers & Suppliers
Report highlights factors hindering improvements in patient matching
Researchers from The Pew Charitable Trusts and the Massachusetts eHealth Collaborative interviewed health care executives and experts and found that all of the respondents agreed that patient matching rates for an effective health data exchange aren't where they want them, which could lead to patient safety issues and delays in care. When asked about the impediments to improved patient matching, respondents cited a lack of data standards and perceived costs of solutions, and a majority of participants said creating a unique patient identifier could help address cost issues.
Health IT Analytics (5/15) 
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7 things you need to know about PBM models
Contracting with a pharmacy benefit manager (PBM) is no small task. It's complex and requires a leap of faith to hand over the management of millions to a 3rd party. Learning the differences between traditional and pass-through models can save payors 10-15% on Rx benefit costs. Download the E-book
Medical Update
Fast walkers may have longer life expectancy, study shows
UK researchers found that people with body weights ranging from underweight to obese who walked more briskly had a longer life expectancy than those who walked slowly. Published in Mayo Clinic Proceedings and based on data from more than 470,000 people from the UK Biobank, findings suggest that physical fitness may be a better life expectancy indicator than body mass index.
United Press International (5/15) 
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Study: Low-fat diet may reduce breast cancer mortality risk
Follow-up data from the Women's Health Initiative that spanned almost 20 years showed women who ate a low-fat diet were 21% less likely to die from breast cancer, compared with those who followed a more typical high-fat diet, researchers said at an American Society of Clinical Oncology briefing ahead of the group's annual meeting. Of the women who did develop breast cancer, those who ate a low-fat diet had a 15% reduced risk of dying from any cause.
MedPage Today (free registration) (5/15) 
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What to look for in a Real Time Benefit solution
Clarity around pharmacy's role in a value-based world has been slow to emerge, but industry stakeholders are beginning to understand how pharmacy-focused solutions such as Real-Time Benefit (RTB), can support VBC goals to provide effective care at the appropriate price through the appropriate channel. Read the whitepaper.
Emerging Trends
CVS Health program validates contents of vitamin, supplement products
CVS Health program validates contents of vitamin, supplement products
Amid concerns about regulatory lapses in the vitamin and supplements industry, CVS Health has launched a program called "Tested to Be Trusted" to ensure that all vitamins and supplements sold at its stores contain the expected ingredients and do not include contaminants. Seven percent of the 1,400 items tested so far failed and either had their labels corrected or were removed from stores.
Becker's Hospital Review (5/16) 
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Health Insurance Provider Company News
Is telehealth the future of mental health care?
As the relationship between technology and healthcare continues to evolve, there is one area that seems to be experiencing more disruption than ever: mental health. In 2018, a staggering 43.8 million Americans experienced mental illness, but well over half did not seek treatment. Could telehealth change that? Read more.
Solutions Provider News
Pharma News
FDA approves EMD-Pfizer combo as first-line kidney cancer therapy
The FDA approved EMD Serono's Bavencio, or avelumab, plus Pfizer's Inlyta, or axitinib, for patients with previously untreated advanced renal cell carcinoma. In a late-stage study, treatment with the combination significantly improved the median progression-free survival of patients versus sunitinib alone.
eMPR (5/15) 
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Pfizer's Fragmin OK'd for pediatric symptomatic VTE
Pfizer's Fragmin, or dalteparin sodium, was approved by the FDA to lessen the recurrence of symptomatic venous thromboembolism in pediatric patients at least 1 month old. The drug was first approved for adult patients with certain types of angina, deep vein thrombosis and symptomatic VTE.
eMPR (5/16) 
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Policy Watch
Administration urges court to reinstate Medicaid work rules in 2 states
A brief filed by HHS and the Justice Department urge a federal appeals court to revive Medicaid work rules in Arkansas and Kentucky, arguing the programs are policy experiments that adhere to Medicaid's mission. "The goal of the policies is to encourage compliance, and the terms and conditions of approval include safeguards intended to minimize coverage loss due to noncompliance," the agencies wrote, adding that the "Supreme Court has long recognized that requirements that enable states to stretch limited resources promote the objectives of public welfare programs."
Modern Healthcare (tiered subscription model) (5/16) 
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Judge: FDA should speed up e-cigarette review
Judge: FDA should speed up e-cigarette review
(Scott Olson/Getty Images)
US District Judge Paul Grimm has ordered the FDA to expedite its reviews of thousands of e-cigarette products in a ruling in favor of the American Academy of Pediatrics and other health organizations, saying that the FDA's decision to delay e-cigarette product reviews by several years was a neglect of its legal duty. Meanwhile, North Carolina has accused Juul in a lawsuit of using youth-targeted advertising and not clearly detailing product-related health risks.
USA Today/The Associated Press (5/15),  United Press International (5/15) 
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Video: Why people buy private health insurance
Wondering what private health insurance is doing for you? Watch this video and learn more.
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Benefit from back-office efficiencies
For plans seeking to contain administrative costs, outsourcing can be a smart solution. TPA Direct members are experts in delivering back-office efficiencies. QualCare, Inc. offers self-funded PPO, HMO network, point of service (POS) network, and open access health plans; third party administration (TPA) services, provider network access, care management services, and a workers' compensation product.
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Webinar: Consumer engagement trends -- register today
Join us on Wednesday, May 22, from 1 p.m. to 2 p.m. ET for "Consumer Engagement: Benchmarking Health Insurance Provider Investments & Priorities" as SingleStone discusses innovative strategies that address consumer demands while optimizing for technology costs and speed to market. Many of these strategies have already been implemented in financial services and banking, offering powerful lessons for the health care industry.
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