CMS proposes allowing plans to exclude copay coupons from spending limits | CMS unveils proposed standards for 2020 ACA health plans | MedPAC suggests giving Part D plans more flexibility
January 18, 2019
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CMS proposes allowing plans to exclude copay coupons from spending limits
The CMS proposed allowing health insurance plans sold on Affordable Care Act exchanges to exclude the value of drugmakers' copay coupons from subscribers' out-of-pocket limits if a medically appropriate generic alternative is available.
Politico Pro (subscription required) (1/17) 
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Legislative & Regulatory News
CMS unveils proposed standards for 2020 ACA health plans
The CMS unveiled its proposed notice of benefit and payment standards for Affordable Care Act plans for the 2020 coverage year and it includes proposals to lower ACA user fees, allow insurers to adopt midyear prescription formulary changes and increase the annual cost-sharing limit to $8,200 for self-only coverage and $16,400 for family coverage. The agency also asked for comments on how it might address the practice of silver-loading -- concentration of premium increases in silver plans -- and indicated support for a legislative fix enabling cost-sharing reduction payments to resume.
Modern Healthcare (tiered subscription model) (1/17) 
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MedPAC suggests giving Part D plans more flexibility
The Medicare Payment Advisory Commission suggested that Part D plan carriers cover a larger percentage of costs for seniors in the coverage gap but also suggested giving carriers more flexibility.
InsideHealthPolicy (subscription required) (1/17) 
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Front door to US health care could soon be a pharmacy/clinic
The front door to US health care for decades has been its hospitals but the CVS Health acquisition of Aetna could change that to drugstores and clinics staffed by nurse practitioners, said industry consultant Ken Kaufman. CVS Health plans to begin guiding Aetna health plan members to CVS pharmacies and MinuteClinics for a variety of services.
HealthLeaders Media (1/16) 
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Drug Industry Spotlight
EpiPen alternative launched in institutional settings
Adamis Pharmaceuticals and Novartis's Sandoz unit have launched a prefilled epinephrine syringe for treatment of emergency allergic reactions. The syringe, Symjepi, will be available in institutional settings before expanding to the retail market, and it costs less than Mylan and Teva's generic versions of the EpiPen.
FiercePharma (1/17) 
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Editor's Note
PCMA SmartBrief will not publish Monday
In observance of Martin Luther King Jr. Day, PCMA SmartBrief will not be published Monday. Publication will resume Tuesday.
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I liked being half-educated; you were so much more surprised at everything when you were ignorant.
Gerald Durrell,
naturalist and television presenter
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PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 266 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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