Community Hospital Corporation’s Post

Are you a Medicare beneficiary who is struggling to lose weight? You could be one of the 3.6 million enrollees who may now qualify for coverage of the anti-obesity drug, Wegovy. Check out details about eligibility, cost, and how this could affect premiums: https://bit.ly/3UcLkPm #Medicare #weightloss

Are you a Medicare beneficiary who is struggling to lose weight? You could be one of the 3.6 million enrollees who may now qualify for coverage of the anti-obesity drug, Wegovy. Check out details about eligibility, cost, and how this could affect premiums: https://bit.ly/3UcLkPm #Medicare #weightloss

Are you a Medicare beneficiary who is struggling to lose weight? You could be one of the 3.6 million enrollees who may now qualify for coverage of the anti-obesity drug, Wegovy. Check out details about eligibility, cost, and how this could affect premiums: https://bit.ly/3UcLkPm #Medicare #weightloss

Pretty big news in the #GLP1 and #obesity care space today, with #CMS now saying they will cover agents (with CV outcomes data and approval) to reduce the risk of major cardiovascular adverse events (#MACE) in patients with established #cardiovascular disease. The big surprise (to me, at least) is that CMS made this change by regulation instead of waiting for a change in law. While this decision is within CMS's statutorily defined abilities, that they took the step is encouraging. Particularly because the government will negotiate prices by active ingredient (e.g., Ozempic and Wegovy), the immediate-term opportunity to open access to Medicare-covered patients incentivizes CV outcomes trials for any agent that might get both a weight management label along with any other indication that would be covered. Since this change impacts Part D plans, an open question is how these plans will verify the drug is used for MACE reduction versus "just" weight reduction. In this area, it will be instructive to follow all three of the policy, process, and PA form. https://lnkd.in/gZV_keKn

As president of the Lower Out-of-Pockets NOW Coalition, I can’t thank President Biden enough for endorsing the coalition's newest proposal to put a cap on drug costs. Read more about the proposal here: https://lnkd.in/eRxpWBgF #betterhealthcare #democracynow #healthcaresystem #betterhealth #healthinsurance #insuranceindustry #politics #congress #healthcarenow #improvehealthcare #drugcosts #medicalcosts #hospitals #healthsystems #healthylifestyle #healthpolicy

The latest from 340B Report: As CMS Extends Comment Period on 340B Repayments, Hospitals Urge Changes - https://lnkd.in/eGufpWX3 Provider Groups Oppose 340B Provisions in Committee Chair’s Drug Shortage Bill - https://lnkd.in/em-wAjRf Strengthening 340B Program Integrity to Improve Accountability and Confidence - https://lnkd.in/eJ2Tc9Sd PhRMA to Federal Appeals Court: Arkansas Enforcing 340B Contract Pharmacy Law; Seventh Drugmaker Sues Over IRA - https://lnkd.in/edfijauj Tolmar Providing Refunds for Five Years of 340B Overcharges - https://lnkd.in/ekTDUCte Five Value Pillars for 340B Program Compliance - https://lnkd.in/ehrK-VyM To get full access to 340B Report news reporting and analysis, visit https://lnkd.in/gJd7qNyg #340B #pharmacy #hospitals #drugspharmaceuticals #drugpricing

Congress is Knocking on 340B's Door, Saying "Show Me the Money" 💵 Many members of society are adversely affected by inequalities stemming from diverse circumstances and socio-economic realities. Disparities in public health result from those inequalities. Policy is one avenue for improving the health of those in need. One policy response by Congress was the creation of the 340B Drug Pricing Program as part of the bipartisan Veterans Healthcare Act of 1992. The 340B program allows qualifying safety-net providers and qualifying hospitals, otherwise known as covered entities, to purchase prescription drugs at significantly discounted prices from manufacturers and re-invest those dollars in expanding access to care and treatment. A growing chorus is concerned that the legislative intent of the program is being obfuscated by large hospital systems and mega service providers. Read more: https://lnkd.in/gNSpZkMP

CareSet commented last week on CMS’ proposed rule to increase drug price transparency in Medicaid. Changes could include CMS surveying manufacturers of certain high cost outpatient drugs to understand what factors make that drug expensive. And requiring contracts with PBMs to be more transparent so that “spread pricing” and the actual cost of outpatients drugs are apparent. We support this proposed rule, but in three areas we suggest alternative approaches to protect patients and transparency: 1. Drug suspension or termination in the Medicaid program could restrict necessary drugs for patients, and we propose that CMS find alternative ways to enforce their transparency initiatives. 2. A separate RFI should be created on the potential for diagnosis codes to be required alongside prescriptions. 3. CMS should not proactively label pricing information as proprietary, and should instead leave such decisions to FOIA, the courts, and existing laws. As always, we applaud all progress on #drugpricing transparency in #medicaid and #medicare from Centers for Medicare & Medicaid Services. Our full comments are available here: https://lnkd.in/ehpqMXe2 And here I am in the moment of happiness when comments are done and submitted! Bonus: cat and spider.

Congress tries to help rural communities, then greedy hospitals and pharmacies undermine rural programs. Perhaps the complexities of our healthcare system creates smokescreens for abusers? How does the 340B Drug Pricing Program coordinate with the Inflation Reduction Act to achieve lower prices for seniors? Has this program coordinated with Medicare Part D in the past? #medicarepartd #seniors #drugdiscount #340bdrugpricingprogram #drugsavings https://lnkd.in/g9uE-eh2

Pharmacy Benefit Managers (PBMs) aren't passing along manufacturer rebates to patients. As the new GAO study reports, PBMs pocket the "savings" that are supposed to lower drug costs. "Part D plan sponsors got more than $48 billion in rebates from drug companies in 2021, but the patients who take the medicines that are generating all those savings are losing out, the study suggests. The reason: Medicare Part D enrollees’ costs at the pharmacy counter are based on the drug’s gross cost before any rebates, the GAO said."