The Public Health Service Act 340B Drug Pricing Program enables providers that serve vulnerable patient populations to access outpatient drugs at significantly lower costs, which helps improve overall patient care. Since the Medicaid Drug Rebate Program and the 340B Drug Pricing Program were established in the early 1990s, stakeholders have struggled to resolve questions surrounding duplicate discounts. Expanding these programs under the Affordable Care Act in 2010 exacerbated the issue and further complexity will be added through the Inflation Reduction Act.
The $740 billion Inflation Reduction Act, signed by President Biden on August 16, 2022, will have significant implications for pharma, payers, and seniors.The bill implements several significant changes like beginning in 2026, US Department of Health and Human Services will be negotiating directly with pharmaceutical companies for the 10 most expensive Medicare drugs; number increasing to 20 new Part D and B drugs in 2029.
On June 15, 2022, the Supreme Court of the United States (SCOTUS) ruled in favor of hospitals over Medicare regarding a 340B reimbursement policy instituted in 2018 and unanimously decided that the almost 30% in cuts to Medicare outpatient drug payments for hospitals participating in the 340B drug pricing program was unlawful.
Examine the evolving world of payviders, including the evolution of the convergence of payers and providers in the future of healthcare, with Dominic Galante.
Dive into the world of the Quality Payment Program (QPP) as Dominic Galante reintroduces us to the purpose behind the shift from volume to value, the laws that have catalyzed this shift, and the resultant APMs.
With the new changes in the latest CMS 340B rules and policies regarding patient access to discounted drugs, there will certainly be challenges between pharma and contracted pharmacies. Precision’s Dominic Galante discusses the potential positions that will be taken by plaintiffs, and the associated 340B Program litigation.
What are the key takeaways and approaches to delivering unique membership experiences and building loyalty to regional Medicare plans? Precision’s Dominic Galante examines how these plans will keep members engaged and enrolled, one of their top priorities, among the uncertainty caused by COVID-19.
As consolidation increases, so too does payer and organized provider buying power. More than ever, biopharmaceutical manufacturers must demonstrate the economic and clinical value of their products. Take a closer look at some of the recent consolidations and how they might impact drug access, coverage, and reimbursement.
Pharmaceutical companies face many challenges: developing life-changing products that meet the needs of patients, physicians, and payers; adhering to regulatory standards; and managing health technology and payer scrutiny—all while trying to satisfy investors. Dominic Galante, chief medical officer with our Quality and Population Health Solutions team, makes the case that the patient perspective on value has never been more important.