Americans For Safe Access’ Post

Prohibitive costs, provider shortages, and geographic restrictions are just some of the barriers faced by the 20% of US adults experiencing a mental illness when seeking treatment. Mental health care in the US faces a chronic shortage of qualified professionals and has been neglected in terms of the development of new treatments. Prescription digital therapeutics (PDTs) are software-based interventions that are clinically validated and authorized by the FDA. They are designed to address the current barriers faced by patients when seeking treatment. However, there has historically been little legislative support to ensure that PDTs are accessible to those who need them the most. The US Congress has recently taken steps to formalize guidance on Medicare and Medicaid coverage and reimbursement for PDTs, extending key legislation so that it applies to manufacturers of medical devices as well as drug-based therapies. As the PDT market continues to grow, more recognition from legislators and payers will be necessary to ensure patients can access these potentially transformative products. Read on in our article from Katie Hayes, Rachel Rothschild, MPH, and Wojciech (Voytech) Sudol, MBA to hear how policy initiatives can improve access to PDTs: https://buff.ly/45AQRnd #DigitalTherapeutics #PDTs #MentalHealth #MarketAccess

Prohibitive costs, provider shortages, and geographic restrictions are just some of the barriers faced by the 20% of US adults experiencing a mental illness when seeking treatment. Mental health care in the US faces a chronic shortage of qualified professionals and has been neglected in terms of the development of new treatments. Prescription digital therapeutics (PDTs) are software-based interventions that are clinically validated and authorized by the FDA. They are designed to address the current barriers faced by patients when seeking treatment. However, there has historically been little legislative support to ensure that PDTs are accessible to those who need them the most. The US Congress has recently taken steps to formalize guidance on Medicare and Medicaid coverage and reimbursement for PDTs, extending key legislation so that it applies to manufacturers of medical devices as well as drug-based therapies. As the PDT market continues to grow, more recognition from legislators and payers will be necessary to ensure patients can access these potentially transformative products. Read the full article by Katie Hayes, Rachel Rothschild, MPH, and Wojciech (Voytech) Sudol, MBA to hear how policy initiatives can improve access to PDTs. https://buff.ly/44zCGgJ #DigitalTherapeutics #PDTs #MentalHealth #MarketAccess

Plan sponsors that provide prescription drug coverage for Medicare Part D coverage must annually disclose whether that coverage is considered creditable or non-creditable. This reporting requirement applies to both self-funded and fully insured group health plans and also applies whether the prescription drug coverage is primary or secondary to Medicare. #compliance #medicare #prescriptiondrugs

HealthPayerIntelligence poses the question: How are Medicare plans lowering drug costs for beneficiaries? The article cites AMCP's position statement noting that preferred #pharmacy networks is one way to advance the shift towards value-based care. Learn more: https://bit.ly/3QLpZM3 #managedcare #medicare

**IMPORTANT INFORMATION** The annual Medicare Part D enrollment period, which generally runs from October 15 until December 7 each year, is quickly approaching.  For employers who offer prescription drug coverage, that means they must distribute a notice of "creditable" or "non-creditable" coverage to Medicare-eligible individuals before October 15. This notice requirement applies to all employers who sponsor a prescription drug coverage plan, regardless of plan size, ACA grandfathered status, or whether fully-insured or self-funded. https://lnkd.in/g8Jmn-xZ

Seems like an awfully rosy analysis by the government. As we approach an election year, no coincidence. Not to be a curmudgeon, but I’ll offer an alternative analysis. Drug costs still high, middlemen still running amok, Medicare drug negotiation tied up in court and was too limited anyway, insulin price caps don’t touch the many other drugs preferred for diabetics, med D out of pocket cap doesn’t start until next year, and the last 2 are just cost shifting that by default will raise premiums unless we pass a law that shifts costs somewhere else. Hey government, got any more good ideas? #pharmacy #pharmacist #healthcare #healthcarecosts #drugprices #inflationreductionact #healthcare #ira https://lnkd.in/geV9MDcx

Don't miss out on important information when enrolling in Medicare! Many people forget to ask the right questions, but we're here to help. Whether it's for yourself, your family, employees, or friends, give us a chance to provide the additional info you need. #cmedicare

Did you know that 63% of Minnesotans make less than 100K a year? Yet, on average, we continue to pay over $20,000 in premiums to cover a family of four. Why is this happening? The answer lies with Pharmacy Benefit Managers or PBMs. These third-party companies act as intermediaries between insurance providers and pharmaceutical manufacturers, creating formularies, negotiating rebates, processing claims, creating pharmacy networks, reviewing drug utilization, and managing mail-order specialty pharmacies. However, PBMs are not always friendly to employers or employees. Most do not offer programs that could help median-income families access patient assistance programs to access medications, which provide lower out-of-pocket costs for employees and lower claims to group health plans. This is driving up costs and leading to higher premiums for higher cost health plans, which can result in losing talented people. It's not that hard; it matters who you work with. This year, let's talk more about PBMs and how they impact our healthcare system.

If you tuned in to Senate Finance Committee hearing yesterday, you probably heard Chairman Wyden, Senator Cassidy and Senator Cortez Maso asking me about an upcoming paper on generic reimbursement. This is the paper! 🔸 Methods 🔸 ➖ We evaluated point of sale reimbursement rates for the top 50 generics by Part D spending by the leading Part D organizations ➖We compared reimbursement rates to NADAC as measure of acquisition cost 🔸 Results🔸 ➖We found 16 generics with reimbursement rates > 1000% mark up ➖For instance, aripiprazole cost 17 cents / tablet. 🔺Rite Aid paid for it $11.7, or a 7000% mark up 🔺Cigna paid $4.6, a 2760% mark up 🔺CVS Health paid $4.5, a 2700% mark up ➖Imatinib cost $4.2/tablet. 🔺Rite Aid paid for it over $250, CVS Health $245 (both nearly 6000% mark up) 🔺We are talking of mark ups of $7000 per 30-day prescription https://lnkd.in/edX9CVhf 🔸 Implications🔸 ➖It is unclear to what extent these point-of-sale reimbursement rates are offset by clawbacks BUT ➖These practices are quite concerning because co-insurance is applied to these inflated amounts, which means that seniors end up paying higher out-of-pocket expenses ➖Policy reform is urgently needed to prevent these practices. And that is exactly what I told the Committee yesterday I appreciate the Senators' attention to these concerning practices. It was an incredible honor to be able to present the findings to the Committee right as the paper was published. I just wish our work is helpful to: 1) evidence the shortcomings of the current way how we pay for drugs and 2) inform policy reform. Couldn't have done this without the funding from West Health Policy Center and the support from Sean Sullivan Ryan Hansen Nico Gabriel Cristina Boccuti Anna Kaltenboeck #PartD #PBMs #healthpolicy

Have you heard about the Medicare Extra Help program? "Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. Due to a new law, more people qualify in 2024 for additional savings on their Medicare prescription drug costs. Learn if you qualify for Extra Help: https://lnkd.in/eTnX2Qp5