On March 4, 2014, the Obama Administration released its proposed federal budget for fiscal year (FY) 2015. Virtually all types of health care providers, health plans, and drug manufacturers would be impacted by the budget provisions if adopted as proposed – an unlikely scenario given the Republican House leadership’s reaction to the document. Nevertheless, the Medicare and Medicaid savings proposals (many of which are carry-overs from prior budgets) could resurface as spending offsets in the pending negotiations on Medicare physician fee schedule reform legislation or in future budget negotiations. Highlights of the Administration’s Medicare and Medicaid legislative proposals include the following (all savings estimates are for the 10-year period of FYs 2015-2024):
Continue Reading Obama Administration Proposes FY 2015 Budget with Medicare, Medicaid Savings Provisions
Medicare Part B Drugs
Updated Medicare Part B Drug Files Released
CMS has posted updated average sales price (ASP) files with payment rates for Part B covered drugs for the first quarter of 2014, based on third quarter 2013 data. According to CMS, average drug prices in the market remain relatively stable, with average prices for the top Part B drugs decreasing by 1.4%.
OIG Call for Medicare Part B Drug Rebates Rejected by CMS
A new OIG report estimates that Medicare could realize significant savings if drug manufacturers were required to pay rebates on Medicare Part B drugs, similar to rebates under the Medicaid program. Specifically, Medicare could have collected $3.1 billion in 2011 if manufacturers had been required to pay rebates based on average manufacturer price (AMP)…
CMS Releases Fourth Quarter 2013 Drug ASP Files
CMS has released the October 2013 Medicare average sales price (ASP) file update, which reflects payment amounts be used to pay for Part B drugs for the fourth quarter of 2013. CMS notes that market prices generally remain relatively stable, with average prices for the top Part B drugs decreasing by 0.4% compared to the…
Health Policy Hearings
A number of recent Congressional hearings have focused on health policy issues, including the following:
- The House Energy and Commerce Committee held hearings on bipartisan proposals to redesign the Medicare benefit structure and challenges facing businesses under the ACA. A June 28 hearing will focus on Medicare Part B drug program reforms.
- House Ways and
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July 2013 Update to Medicare ASP Files
CMS has posted the July 2013 Medicare Part B average sales price (ASP) files, containing the payment amounts that will be used to pay for Medicare Part B covered drugs for the third quarter of 2013. CMS observes that average drug prices in the market generally remain stable, with prices for the top Part…
Obama Administration’s Proposed FY 2014 Budget Includes $401 Billion in Health Program Savings
Today, the Obama Administration released its proposed federal budget for fiscal year 2014. As widely reported, the budget incorporates an offer the President made to Congress in December 2012 to achieve nearly $1.8 trillion in additional deficit reduction over the next 10 years, including $401 billion in health savings (the Administration observes that this level of cuts would “provide more than enough deficit reduction to replace the damaging cuts required by the Joint Committee sequestration”).
Virtually all provider types – and drug manufacturers – would be impacted by the budget provisions, if adopted as proposed. The budget proposal is certainly subject to change during the legislative process, particularly as the House and Senate leadership pursue alternative budget frameworks, and indeed, gridlock could prevent significant action on entitlement reform this year. Nevertheless, the proposals bear careful monitoring because they could eventually be included in any long-elusive “grand bargain” to reform the Medicare program and reduce the federal debt.
Highlights of the Administration’s Medicare and Medicaid proposals include the following:Continue Reading Obama Administration’s Proposed FY 2014 Budget Includes $401 Billion in Health Program Savings
April 2013 Update to Medicare ASP Files
CMS has posted the April 2013 Medicare Part B ASP files. CMS observes that average drug prices in the market generally remain stable, with prices for the top Part B drugs decreasing by 0.5% from the first to second quarter of 2013.
OIG Continues to Call on CMS to Implement Medicare Part B Drug Pricing Reforms
For the 29th time, the OIG has issued a report comparing Medicare Part B drug average sales prices (ASP) and average manufacturer prices (AMP), this report covering all of 2011. The OIG again concludes that the Medicare would realize savings if it exercised its authority to lower reimbursement for Part B drugs when the…
OIG Issues Medicare Part B Drug Pricing Report, Calls Out CMS Inaction on Reforms
The OIG has released the most recent in a series of reports comparing Part B drug average sales prices (ASP) and average manufacturer prices (AMP). The latest report (the 28th in the series) compares second quarter 2012 ASPs and AMPs and their impact on Medicare reimbursement for the fourth quarter of 2012. By way…
CMS Releases Medicare Part B Drug ASP Files for January 2013
CMS has issued the Medicare Part B average sales price (ASP) files for the first quarter of 2013. CMS notes that average drug prices in the market generally remain relatively stable, with prices for the top Part B drugs decreasing by 1.2% on average. CMS also states that due to certain “operational issues,” it…
OIG Report on Medicare Part B Drug Pricing Data
The OIG has released its latest report comparing Part B drug average sales prices (ASP) and average manufacturer prices, this one comparing first quarter 2012 ASPs and AMPs and their impact on Medicare reimbursement for the third quarter of 2012. By way of background, the Social Security Act requires the OIG to notify the…
OIG Recommends Resurrection of Least Costly Alternative (LCA) Drug Policy
In a recent report, “Least Costly Alternative Policies: Impact on Prostate Cancer Drugs Covered Under Medicare Part B,” the OIG suggests that CMS consider seeking legislative authority to implement LCA policies for Part B drugs under certain circumstances. By way of background, between 1995 and 2010, Medicare subjected certain Part B prostate cancer…
CMS Finalizes OPPS, ASC Rates and Policies for 2013
On November 15, 2012, the Centers for Medicare & Medicaid Services (CMS) published its publishing its final rule with comment period updating Medicare payment and other policies for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for CY 2013. The rule also updates Medicare quality reporting program policies and various other Medicare policies. Key provisions of the final rule include the following:Continue Reading CMS Finalizes OPPS, ASC Rates and Policies for 2013
CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates
CMS has released its final rule updating the Medicare physician fee schedule (MPFS) for 2013 and modifying numerous other Medicare Part B policies. Most significantly, the final rule includes a 26.5% across-the-board cut in physician fee schedule payments as a result of the statutory sustainable growth rate (SGR) formula. While Congress is widely expected to mitigate this policy in future legislation, the timing and scope of any such “fix” is highly uncertain. The following are highlights of the sweeping rule:Continue Reading CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates
GAO Releases Data on High-Expenditure Medicare Part B Drugs
The GAO has issued a report analyzing trends related to high-expenditure Medicare Part B drugs, which are drug commonly administered by a physician or under a physician’s close supervision in physicians’ offices and hospital outpatient departments. The report provides data on: (1) the highest-expenditure Medicare Part B drugs in 2010 and utilization and spending…
CMS Releases October 2012 Update to Medicare Part B Drug ASP Files
CMS has posted the October 2012 update to Medicare Part B average sales price (ASP) files, which will be used to pay for Part B covered drugs for the fourth quarter of 2012. CMS reports that drug prices in the market remain relatively stable, with average prices for the top Part B drugs decreasing…
OIG Report Reviews Updated Medicare Part B Drug Pricing Data
The Social Security Act requires the OIG to notify the HHS Secretary if the average sales price (ASP) for a particular drug exceeds the drug’s average manufacturer price (AMP) or widely available market price (WAMP) by a threshold, currently set at 5%. If that threshold is met, the Secretary is authorized to disregard the drug’s…
CMS Issues Proposed OPPS, ASC Policies for 2013
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update Medicare payment and other policies for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for calendar year (CY) 2013. The proposed rule also would update Medicare inpatient rehabilitation facility (IRF) quality reporting program policies and various other Medicare policies. The official version of the rule is scheduled to be published in the Federal Register on July 30, 2012. CMS will accept comments on the rule until September 4, 2012. Key provisions of the proposed rule include the following:Continue Reading CMS Issues Proposed OPPS, ASC Policies for 2013
CMS Proposes Update to 2013 Medicare Physician Rates, Other Part B Policies
On July 30, 2012, CMS is publishing a proposed rule updating the Medicare physician fee schedule (MPFS) for 2013 and modifying numerous other Medicare Part B policies. Most significantly, the proposed rule would impose a 27% across-the-board cut in MPFS payments, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although Congress is expected to eventually take action to block the automatic cuts, as it has in the past). Comments on the proposed rule are due by September 4, 2012. The following are highlights of the wide-ranging proposal:Continue Reading CMS Proposes Update to 2013 Medicare Physician Rates, Other Part B Policies