/ en Wed, 30 Apr 2025 16:20:44 -0500 Fri, 24 Jan 25 13:19:12 -0600 /news/headline/2025-01-24-senate-introduces-bill-requiring-price-disclosures-advertisements-prescription-drugs <p>Sens. Dick Durbin, D-Ill., and Chuck Grassley, R-Iowa, Jan. 23 <a href="https://www.durbin.senate.gov/newsroom/press-releases/durbin-grassley-introduce-bill-to-crack-down-on-prescription-drug-advertisements-boost-price-transparency">introduced</a> the Drug-price Transparency for Consumers Act, legislation supported by the AHA that would require price disclosures on advertisements for prescription drugs. The bill would help ensure that consumers are able to make more informed decisions on prescription drugs. </p> Fri, 24 Jan 2025 13:19:12 -0600 Drug Price Transparency /news/headline/2024-10-07-reminder-cms-hosting-webinar-oct-21-price-transparency-machine-readable-file-2025-requirements <p>The Centers for Medicare & Medicaid Services Oct. 21 will host a <a href="https://cms.zoomgov.com/webinar/register/WN_LqZfybX7RAePe8DAPEyx3w#/registration">webinar</a> on meeting its new hospital price transparency requirements becoming effective Jan. 1. These <a href="/news/headline/2024-07-01-new-hospital-price-transparency-requirements-take-effect">requirements</a> include incorporating additional elements into the standard machine-readable format, including an estimated allowed amount and information on modifiers and prescription drugs.</p> Mon, 07 Oct 2024 16:07:26 -0500 Drug Price Transparency /affordability-advocacy-agenda <div class="container"><div class="row"><div class="col-md-8"><h2><span>Advancing Affordability, Value, and Equity in Health Care Priorities for America’s Hospitals and Health Systems</span></h2><p>By all accounts 2020 was an unprecedented and historic year – one that tested our nation, our economy and our health care system like never before.</p><p>Hospitals, health systems and post-acute care providers – along with our doctors, nurses and other team members – have been on the front lines of the COVID-19 pandemic, working tirelessly to provide the best care for patients, families and communities. They have done this – and continue to do this – while facing daunting challenges. These challenges have persisted well into 2021, with continued surges of cases and hospitalizations.</p><p>At the same time, individuals, employers, and the government continue to seek greater value for their health care dollars. Concerns around the affordability of health care will only grow as overall health care spending continues to rise and, especially with respect to publicly-financed programs like Medicare and Medicaid, demographic trends mean that there are fewer workers to help finance this care. There is also a renewed focus on eliminating disparities in care, closing equity gaps, and enhancing quality and patient safety – all of which are integral to achieving greater value.</p><p>Our shared focus with Congress and Administration is on providing relief from the pandemic, ensuring a smooth recovery, and rebuilding a better health care system for the future. The ���������� Association continues to incorporate principles that promote improved affordability, value, and equity into our policy and advocacy activities. Below are some of our key priorities in these areas.</p><h3><span>Making Health Care More Affordable</span></h3><p>In recent years, health care spending growth has largely been driven by increased use and intensity of services. In other words, more people are getting care – and more care – and the care they are getting is more involved than in the past. Much of this is the result of substantial expansions in health care coverage, improved efforts to connect people to needed care, advances in medicine and technology, and growth in the prevalence of chronic disease. In some cases, prices have also risen, such as for prescription drugs. This can impact not only what individuals may pay at the pharmacy counter but also the cost of care provided by hospitals, physicians, and other providers that relies on critical drug therapies. Another substantial cost driver that has dramatically escalated in the past several years is the utilization management processes that health plans have erected and which require significant investments in technology and personnel to manage.</p><p>Hospital care requires a range of inputs such as wages for clinical and other personnel, prescription drugs, administrative software and other technology, food, medical devices, utilities and professional insurance. Steep increases in the prices for certain inputs, like drugs and administrative processes mandated by health plans, can undermine hospitals’ efforts to reduce the cost of care.</p><p>To address the underlying cost drivers in the health care system, we urge Congress and the Administration to:</p><ul><li>Rein in the rising cost of drugs, including by taking steps to increase competition among drug manufacturers; improve transparency in drug pricing; and advance value-based payment models for drugs.</li><li>In the same vein, protect the 340B drug savings program to ensure structurally marginalized communities have access to more affordable drug therapies by reversing harmful policies and holding drug manufacturers accountable to the rules of the program, especially as it relates to community pharmacy arrangements.</li><li>Reduce administrative waste by streamlining prior authorization requirements and processes for hospitals and post-acute care providers, so that clinicians can spend more of their time and resources on direct patient care, not pushing paper and arguing with insurance companies over administrative delays and coverage denials.</li><li>Promote greater efficiency and safeguards against unnecessary burden in HIPAA administrative standards and other rules related to billing and ensure an achievable roadmap toward greater adoption of standard transactions.</li><li>Reduce unnecessary costs in the system by passing comprehensive medical liability reform, including caps on non-economic damages and allowing courts to limit attorneys’ contingency fees.</li></ul><h3><span>Improving the Affordability of Coverage</span></h3><p>In addition, we urge Congress and the Administration to take additional steps to make health care coverage more affordable and easier to use for patients. The entire point of insurance is to share large and unanticipated costs across a pool of people. Coverage is essential for making health care affordable for individuals and families in the same way car insurance enables individual drivers to weather the bad fortune of an unexpected crash. While we have made substantial gains in health coverage over the past decade, we are just beginning to fully understand the crisis of under-insurance that is primarily being driven by high deductible health plans.</p><p>The AHA supports bolstering our current public/private framework for coverage to close the remaining coverage gaps and taking immediate steps to ensure that patients do not face financial barriers to using their coverage. We encourage policymakers to preserve and build on the strong foundation of employer-sponsored coverage and further strengthen the individual market while ensuring that Medicare and Medicaid are available to those who rely on these programs. Specifically, we encourage Congress and the Administration to:</p><ul><li>Take additional steps to close coverage gaps, including by building on the existing incentives to encourage all states to expand Medicaid, making permanent the recent expansions in eligibility and the level of subsidies for coverage on the Health Insurance Marketplaces, and expanding existing outreach and enrollment efforts to ensure that every U.S. resident knows their options for coverage.</li><li>End the sale of products purporting to be health plans but that do not meet all of the consumer protections established in federal law, such as health sharing ministries and short-term limited duration coverage products which can leave patients with high and unexpected medical bills as a result of gaps in coverage.</li><li>Restrict the sale of high deductible health plans to consumers who can afford the associated cost-sharing obligations.</li><li>Ensure patients can rely on their coverage by disallowing health plans from inappropriately delaying and denying care, including by making mid-year coverage changes.</li><li>Protect patients from surprise medical bills and ensure that the implementing regulations do not unintentionally distort health care markets and reduce patient access to care.</li><li>Support price transparency efforts by ensuring patients have access to the information they seek when preparing for care, including cost estimates when appropriate, and creating alignment of federal price transparency requirements to avoid patient confusion and overly burdensome duplication of efforts.</li></ul><h2><span>Advancing Value through Health System Transformation and Enhancements in Quality</span></h2><h3><span>Health System Transformation</span></h3><p>In addition to making the health care system more affordable, hospitals and health systems are committed to ensuring that each dollar brings value. We will achieve this by continuously striving to deliver the highest quality care most efficiently, and that will require rethinking how and where we deliver care. We will also look for opportunities for providers to collaborate with payers and employers to ensure aligned incentives to achieve value, including identifying effective models of risk where appropriate.</p><p>The last decade brought significant changes in the health care landscape, but nothing has accelerated changes in the delivery of health care like the COVID-19 pandemic. During the public health emergency, hospitals and health systems were able to innovate at a pace and scale previously unseen as a result not only of the realities of containing a pandemic but also the regulatory flexibility provided by states and the federal government.</p><p>The AHA is eager to continue these advances and supports policies that:</p><ul><li>Expand use of telehealth, broadband and digital technologies by providing Medicare and Federal Communications Commission funding, coverage, and reimbursement for such services, technology and workforce training.</li><li>Implement policies to better integrate and coordinate behavioral health services with physical health services.</li><li>Build on the progress in modernizing the Stark Law and Anti-kickback Statute regulations that better protect arrangements that promote value-based care.</li><li>Allow providers to determine how best to utilize electronic health records (EHRs) and other technologies while promoting interoperability and access to health information for clinical care and patient engagement.</li><li>Provide robust support to ensure electronic communication between acute care hospitals and psychiatric hospitals and providers, and to encourage psychiatric hospitals and mental health providers to optimally use EHRs.</li><li>Advance use of innovative technologies and software (e.g., clinical decision support algorithms) without increasing regulatory burden by supporting policies that enable clinicians to have the data they need to treat patients and improve health outcomes.</li><li>Invest in health care infrastructure by expanding access to virtual care technologies and high-speed internet, strengthening the capacity and capability for emergency preparedness and response, assisting hospitals in “right-sizing” to meet the needs of their communities, and ensuring adequate financing mechanisms are in place for hospitals and health systems, including for training the workforce.</li><li>Address the impact that social determinants of health have on patient outcomes by improving care coordination and expanding the tools hospitals can use to meet these needs.</li><li>Advance rural health care alternatives to ensure sustainable care delivery and financing including: exploring rural pre-payment models; supporting additional inpatient/outpatient transformation strategies; promoting virtual care strategies; allowing innovative partnerships; and refining existing models that support hospitals serving historically marginalized communities.</li><li>Explore a new payment mechanism for metropolitan anchor institutions that treat a disproportionate number of government-funded or uninsured patients.</li></ul><h3><span>Enhancing Quality and Patient Safety</span></h3><p>America’s hospitals and health systems are world-renowned for the quality of care they provide and are always striving to do even better. Clinicians at U.S. hospitals set the global standard in COVID-19 care, such as by optimizing the use of ventilators for those patients who would most benefit from them. – knowledge that was then shared around the world.</p><p>There is no limit to hospitals’ and health systems’ commitment to quality. However, policy changes are needed to facilitate the identification and adoption of best clinical practices, including addressing challenges with public quality reporting and incentive programs. The AHA encourages policymakers to:</p><ul><li>Continue to streamline and coordinate quality measures in national programs to focus on the “measures that matter” most to improving health and outcomes while reducing burden on providers. These measures should be based on evidence that demonstrates meaningful improvements in patient outcomes are achievable by improving adherence to the measures.</li><li>Advocate for modernized conditions of participation, interpretative guidance and Joint Commission standards that hold hospitals accountable for taking actions that lead to higher-quality and safer care.</li><li>Enhance the effectiveness of the physician quality payment program by advocating for more accurate and meaningful cost measures and data-driven implementation of new program approaches.</li><li>Promote advanced illness management to better honor patients’ wishes at the end-of-life and remove barriers to expanding access to palliative care services.</li><li>Enhance care coordination and improve patient safety by implementing through rulemaking Sec. 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which revises and better aligns the outdated 42 CFR Part 2 regulations with HIPAA, allowing the responsible sharing of substance use disorder treatment records for the purposes of treatment, payment and health care operations.</li></ul><h3><span>Advancing Health Equity, Eliminating Health Care Disparities, and Increasing Diversity and Inclusion</span></h3><p>The COVID-19 outbreak in the U.S. has shown the country what all hospital and health systems leaders have known for years: serious gaps exist in access, cost and quality for patients based on race, ethnicity, gender and gender identity, age, sexual orientation or other demographic and socio-economic factors. Hospitals and health systems are committed to doing the work to address health equity issues. The AHA and its Institute for Diversity and Health Equity (IFDHE) are also committed to advancing health equity, eliminating health care disparities and increasing diversity and inclusion. The AHA supports policies that:</p><ul><li>Pursue strategies and support public policies aimed at improving maternal and child health outcomes with a particular focus on eliminating racial and ethnic disparities.</li><li>Promote health equity by encouraging cultural humility training in medical residency programs and in-service training for health care professionals.</li><li>Promote inclusion of adjustment for sociodemographic factors in quality measurement programs where appropriate to ensure performance measurement and payment adjustments support the efforts to make meaningful improvements.</li><li>Support coordinated collection of race and ethnicity data across federal agencies to elevate understanding of health care needs in Black and Latino Americans, Native Americans and other communities of color.</li><li>Increase funding for the health equity infrastructure in the Department of Health and Human Services, including the National Institute on Minority Health and Health Disparities, to better research and address the needs of communities of color.</li><li>Support efforts to increase diversity in the health care workforce, including through federal grants to minority-serving institutions for scholarships.</li><li>Repeal the June 2020 final rule that narrowed the scope of non-discrimination protections under Section 1557 of the Affordable Care Act.</li></ul></div><div class="col-md-4"><p><a href="/system/files/media/file/2019/09/report-affordability-agenda-0919.pdf" target="_blank" title="Click here to download the AHA Affordability Advocacy Agenda 2021 PDF."><img src="/sites/default/files/inline-images/Page-1-Affordability-Advocacy-Agenda-2021-10-15.jpg" data-entity-uuid="f0cf703c-d05d-4774-9ecd-c00015b522d3" data-entity-type="file" alt="Page one of the AHA Affordability Advocacy Agenda 2021." width="2550" height="3311"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2019/09/report-affordability-agenda-0919.pdf" target="_blank" title="Click here to download the AHA Affordability Advocacy Agenda 2021 PDF.">Download PDF</a></div><p><a href="/costsofcaring" target="_blank" title="Click here for more information."><img src="/sites/default/files/2022-08/costs-of-caring-report-cover_Page_1.png" data-entity-uuid data-entity-type="file" alt="Costs of Caring 2022 Cover." width="1159" height="1500"></a></p><div class="external-link spacer"><a class="btn btn-primary btn-wide" href="/system/files/media/file/2022/04/2022-Hospital-Expenses-Increase-Report-Final-Final.pdf" target="_blank">Download PDF</a></div><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title">Affordability Resources</h3></div><div class="panel-body group2"><p><a href="/issue-brief/2019-09-18-real-affordability-solutions-front-lines-caring" target="_blank" title="Click here to go to the Real Affordability Solutions from the Front Lines of Caring landing page.">Real Affordability Solutions from the Front Lines of Caring</a></p><p><a href="/costsofcaring" target="_blank" title="Click here to view the Cost of Caring report.">Cost of Caring</a></p><p><a href="/standardsguidelines/2021-10-08-partnerships-mergers-and-acquisitions-can-provide-benefits-certain" target="_blank">Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities</a></p><p><a href="/guidesreports/2021-09-21-financial-effects-covid-19-hospital-outlook-remainder-2021" target="_blank">Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021</a></p><p><a href="/guidesreports/2021-09-09-results-2018-tax-exempt-hospitals-schedule-h-community-benefit-reports" target="_blank">Results from 2018 Tax-Exempt Hospitals’ Schedule H Community Benefit Reports</a></p><p><a href="/news/perspective/2021-10-08-perspective-confronting-commercial-insurers-practices-threaten-patient" target="_blank">Perspective: Confronting Commercial Insurers’ Practices that Threaten Patient Care</a></p><p><a href="/news/blog/2021-07-12-lown-institute-report-hospital-community-benefits-falls-short" target="_blank">Lown Institute Report on Hospital Community Benefits Falls Short</a></p><p><a href="/news/headline/2021-09-28-study-health-insurance-market-becoming-more-concentrated">Study: Health insurance market becoming more concentrated</a></p><p><a href="https://www.ama-assn.org/delivering-care/patient-support-advocacy/competition-health-insurance-research">Report: American Medical Association Report on Competition in the Health Insurance</a></p></div></div></div></div></div> Tue, 13 Aug 2024 10:00:00 -0500 Drug Price Transparency /news/headline/2024-07-11-senate-aging-committee-holds-hearing-transparency-health-care-costs <p>The AHA submitted a <a href="/testimony/2024-07-11-aha-senate-statement-record-health-care-transparency-lowering-costs-and-empowering-patients" target="_blank">statement</a> July 11 for a Senate Special Committee on Aging <a href="https://www.aging.senate.gov/hearings/health-care-transparency-lowering-costs-and-empowering-patients" target="_blank">hearing</a> on health care transparency and lowering health care costs. The AHA highlighted commercial insurer operating methods and prescription drug costs as cost drivers incurred by hospitals and health systems. AHA urged Congress for additional oversight of Medicare Advantage plans to stop tactics that restrict and delay care access and called for regulatory and legislative solutions to improve prior authorization processes. Recent legislative efforts to no longer recognize price estimator tools as a method to meet the shoppable services requirement of the Hospital Price Transparency Rule are also a concern, AHA said. As Congress looks at statutory adjustments to the rule, AHA urged consideration of the changes that the Centers for Medicare & Medicaid Services makes on a regular basis. The most recent changes are related to standardization, new data elements, file accessibility, an accuracy and completeness affirmation and changes to CMS’ monitoring and enforcement processes.</p> Thu, 11 Jul 2024 14:49:21 -0500 Drug Price Transparency /lettercomment/2024-06-25-aha-letter-reps-fischbach-and-pence-expressing-support-congressional-review-act-cra-resolutions <p>June 24, 2024</p><table><tbody><tr><td>The Honorable Michelle Fischbach<br>U.S. House of Representatives<br>1004 Longworth House Office Building<br>Washington, DC 20515</td><td>The Honorable Greg Pence<br>U.S. House of Representatives<br>404 Cannon House Office Building<br>Washington, DC 20515</td></tr></tbody></table><p>Dear Representatives Fischbach and Pence:</p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) writes in support of H.J.Res. 139, a joint resolution for congressional disapproval of a rule relating to<strong> "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting."</strong></p><p>The AHA and its members are committed to safe staffing to ensure high-quality, equitable and patient-centered care in all health care settings, including long-term care (LTC) facilities. Yet, the process of safely staffing any health care facility is about much more than achieving an arbitrary number set by regulation. It requires clinical judgment and flexibility to account for patient needs, facility characteristics, and the expertise and experience of the care team. The Centers for Medicare & Medicaid Services’ (CMS) one-size-fits-all minimum staffing rule for LTC facilities creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements.</p><p>Safe staffing is complex and dynamic. It must account for the acuity of the patients’ needs, the experience and clinical expertise of the nurses and health care professionals on the care team, and the technical capabilities of the facility. Mandated nurse staffing standards remove from the practice of nursing real-time clinical judgment and flexibility. Numerical staffing thresholds do not consider advanced capabilities in technology or the interprofessional team care model that supports data-driven decision-making and collaborative practice. Emerging care models incorporate nurses at various levels of licensure, respiratory therapists, occupational therapists, speech-language pathologists, physical therapists and case managers. A simple mandate of a base number of registered nurse (RN) and nurse aide hours per resident day emphasizes staff roles of yesterday, rather than what current and emerging practices may show is most effective and safe for the patient, and best aligned with the capabilities of the care team. AHA is concerned that these rigid standards will stymie innovation in care delivery.</p><p>The AHA also is concerned that this final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise performing well on quality and safety metrics. The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities. The AHA <a href="/system/files/media/file/2022/12/Issue-Brief-Patients-and-Providers-Faced-with-Increasing-Delays-in-Timely-Discharges.pdf" target="_blank">has already documented</a> rising lengths of stay for hospital patients in need of skilled post-acute care, with patients waiting days, weeks or even months for post-acute care placements. As those patients continue to occupy hospital beds, other patients awaiting elective surgeries or other scheduled procedures may find their care disrupted because there is no bed for them in the hospital. Even more troubling, this final rule could lead to delays in urgent medical care as patients coming into hospital emergency departments (EDs) may experience longer waits as EDs and inpatient beds are occupied by patients awaiting nursing home placements. The AHA <a href="/lettercomment/2023-10-26-aha-comments-long-term-care-facility-minimum-staffing-proposed-rule" target="_blank">urged</a> CMS not to finalize the rule and to instead focus on developing more patient and workforce-centered approaches to safely staff nursing facilities.</p><p>Lastly, we believe this final rule could exacerbate the already serious shortages of nurses and skilled health care workers across the care continuum. The agency estimates that 79% of LTC facilities would have to increase staffing to meet the proposed standards, including the new standard requiring 24/7 RN staffing. Considering the massive structural shortages described by recent studies, it is unclear from where this supply of nurses will come, and it is inconceivable that LTC facilities will be able to meet these standards without detrimental effects to workforce availability throughout the care continuum. Strengthening the health care workforce requires investment and innovation, not inflexible mandates. <strong>Therefore, AHA supports H.J.Res 139 for Congress to disapprove this rule and prohibit the Secretary of Health and Human Services from implementing or enforcing this rule.</strong></p><p>Sincerely,<br>/s/<br>Stacey Hughes<br>Executive Vice President</p><p> </p> Mon, 24 Jun 2024 17:16:00 -0500 Drug Price Transparency /aha-center-health-innovation-market-scan/2024-05-21-3-ways-glp-1-drugs-could-impact-your-hospitals-future <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/3-Ways-GLP-1-Drugs-Could-Impact-Your-Hospitals-Future.png" data-entity-uuid="ce97c59c-d5c6-462c-835b-4b0940d65a82" data-entity-type="file" alt="3 Ways GLP-1 Drugs Could Impact Your Hospital’s Future. Two vials and four tablets of Glucagon-like peptide-1 agonist (GLP-1) drugs." width="100%" height="100%"></p><p>Glucagon-like peptide-1 agonist drugs have been surging in popularity, and manufacturers are scurrying to keep up with demand. The relatively new drugs — the first being approved by the Food and Drug Administration (FDA) in 2005 — also signal a significant shift in how hospitals and health systems treat chronic conditions such as type 2 diabetes and heart disease.</p><p>GLP-1 agonist drugs are most often used to help type 2 diabetes patients lower their blood sugars or to help patients with heart disease prevent heart attacks or strokes, but some also can help treat obesity and soon could be approved for sleep apnea and other treatments.</p><p>Just how far these drugs have penetrated the marketplace was illustrated in a <a href="https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/" target="_blank" title="Kaiser Family Foundation KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 Drugs">Kaiser Family Foundation (KFF) tracking poll</a> released this month. The data paint a clearer picture of the demographics of those taking these drugs and the difficulties many are having with affordability.</p><h2><span>Zeroing In on GLP-1 Users</span></h2><p>The survey found that:</p><ul><li>About one in eight adults <span><strong>(12%)</strong></span> say they have taken a GLP-1 drug, including 6% of adults who are currently taking one of these medications.</li><li>The shares of adults who report ever taking these drugs is highest among people with diabetes (43%), followed by those with heart disease <span><strong>(26%)</strong></span> and those who are obese or overweight (22%).</li><li>Most respondents <span><strong>(62%)</strong></span> who have ever taken a GLP-1 drug say they took the drugs to treat a chronic condition such as diabetes or heart disease. But nearly four in 10 <span><strong>(38%)</strong></span> say they took the drugs solely to lose weight.</li><li>More than half of those who have used GLP-1s say they found it difficult to afford the drugs even with insurance, rebates and discount coupons.</li></ul><p>A separate KFF analysis from March about Medicare Part D spending data from the Centers for Medicare & Medicaid Services found that gross Medicare spending on the three newest versions of GLP-1 diabetes medicines (Ozempic, Rybelsus and Mounjaro) that also have been approved for weight loss skyrocketed from $57 million in 2018 to $5.7 billion in 2022. Overall, the GLP-1 market is expected to experience annual growth exceeding 20% and will hit $133 billion worldwide by 2030, according to a MarketWatch report from February.</p><h2><span>3 Takeaways on GLP-1s and the Future</span></h2><h3><span>1</span> <span>|</span> Beyond weight-loss applications to treating cardiovascular disease.</h3><p>Hospitals clearly are feeling the impact from the growing use of GLP-1s and widespread weight loss could affect providers’ operations downstream. In a double-blind study, semaglutide, a medication that acts like the GLP-1 hormone made by the body after eating, significantly benefited patients who were overweight or obese who had a history of heart disease but no diabetes.</p><p>The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2307563?query=featured_home" target="_blank" title="Teh New England Journal of Medicine: Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes">study</a>, published in November in the New England Journal of Medicine, found that patients who took the medication had lower rates of significant heart events like heart attack and stroke than patients who took a placebo.</p><h4>Takeaway</h4><p>Jorge Plutzky, M.D., a Mass General Brigham cardiologist who was instrumental in designing and running the trial as a steering committee member, noted that the landmark study means semaglutide could help large numbers of patients with heart disease in the future. Some manufacturers already are investing heavily in efforts to expand their production. Novo Nordisk, which manufactures the popular weight-loss drug Wegovy, earlier this year paid $11 billion for three fill-finish manufacturing sites that in part will help ramp up its production of drugs to treat obesity and diabetes.</p><h3><span>2</span> <span>|</span> Health systems partner for data insights on GLP-1s.</h3><p>Researchers continue to study the effects of these drugs on different conditions and populations and to test for secondary indications to treat other diseases. As they do, they will need large volumes of data and artificial intelligence (AI) technology computational analysis.</p><p>Dandelion Health, a tech startup, recently launched a <a href="https://dandelionhealth.ai/glp1-data-library" title="Dandelion: GLP-1 Data Library" taregetr="_blank">GLP-1 data library</a> to share insights and opportunities related to the drug class. The platform features real-world data on an AI platform. The company worked with three health system partners — Sanford Health, Sharp HealthCare and Texas Health Resources — to collect structured and unstructured data from more than 10 million patients across a range of populations and longitudinal patient journeys.</p><h4>Takeaway</h4><p>The vision is for real-world patients on each of these drugs to be followed over the next two to four years to see what happens to their cardiac risk scores, and how that relates to their body mass index or other comorbidities. Perhaps other medicines will surface that do a comparable or better job for select patient groups.</p><h3><span>3</span> <span>|</span> Broader indications for GLP-1s could be coming.</h3><p>With GLP-1s already approved for treating type 2 diabetes and cardiovascular disease, researchers now are assessing the efficacy of these drugs for other medical conditions.</p><h4>Takeaway</h4><p>FDA approval for a GLP-1 drug to treat sleep apnea could come soon, some analysts predict. Meanwhile, researchers are assessing the efficacy of these drugs to treat such conditions as Alzheimer’s disease, substance-use disorder, kidney disease, smoking cessation and more. Regardless of what broader uses may be on the horizon, hospitals and health systems will need to evaluate how these medications change patient risk factors and current treatments and provide wrap-around services for patients who use these medications.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 21 May 2024 06:15:00 -0500 Drug Price Transparency /aha-center-health-innovation-market-scan/2023-12-12-cost-plus-drug-pricing-models-gain-momentum-will-they-last <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/Cost-Plus-Drug-Pricing-Models-Gain-Momentum-but-Will-They-Last.jpg" data-entity-uuid="84306c74-112b-4277-837b-e22d14080cef" data-entity-type="file" alt="Cost-Plus Drug Pricing Models Gain Momentum, but Will They Last? An assortment of different drugs." width="100%" height="381"></p><p>Pharmacy benefits managers (PBMs) have come under increasing pressure from regulatory bodies, states and the federal government, provider organizations as well as startup PBMs to deliver more transparent pricing and lower costs. Now, it appears that these efforts may be having an impact — at least if recent actions by major drug retailers CVS Health and Walgreens are any indication.</p><p>Both CVS and Walgreens recently announced new programs designed to reduce prescription drug prices for many patients and bring greater price transparency to consumers and, in CVS’ case, a new pharmacy reimbursement model.</p><p>CVS Health plans to launch its <a href="https://www.cvshealth.com/news/company-news/our-path-to-accelerating-long-term-growth.html" target="_blank" title="CVS Health: CVS Health highlights path to accelerating long-term growth through building a world of health around every consumer">CVS CostVantage and CVS Caremark TrueCost</a> programs in 2025. CostVantage will define the drug cost and related reimbursement with contracted PBMs and payers, CVS noted in a statement.</p><p>The Caremark TrueCost program is designed to offer clients more visibility into prescription drug pricing and administrative fees. TrueCost prices will be based on the net cost of drugs with defined fee structures. Employers and other clients will have the choice of whether to use the service, the company states.</p><h2><span>CVS’ New PBM Reimbursement Model</span></h2><p>Sometime next year, CostVantage will offer new prices to consumers who pay cash for their prescriptions using a variety of drug discount cards. The program will be incorporated into CVS’ pharmacy contracts in 2025 with PBMs being paid for under employer plans. CVS states that the change isn’t expected to adjust its pharmacy margins, but would ensure more stable and predictable earnings.</p><p>The retailer plans to use a transparent formula built on the cost of the drug, a set markup and a fee that reflects the care and value of pharmacy services. If that sounds familiar to billionaire Mark Cuban’s Cost Plus Drug model, it’s because it is. Cost Plus Drugs charges a flat 15% markup over its cost, plus pharmacy fees. CVS, however, has not disclosed its drug markups or its flat fees.</p><p>Nevertheless, with CVS and its 10,000 retail locations, the cost-plus model for pharmaceutical pricing could have a significant impact on the drug market, according to Adam Fein, CEO of Drug Channels Institute. “It’s a fundamental change in how pharmacy services are priced [and] a legitimate step toward price transparency,” Fein recently told the <a href="https://www.wsj.com/health/healthcare/prescription-drug-costs-cvs-pharmacy-56acb623" target="_blank" title="The Wall Street Journal: CVS Plans to Overhaul How Much Drugs Cost">Wall Street Journal</a>.</p><p>Walgreens, meanwhile, is partnering with the medication access and transparency tech company RxSense to create a digital marketplace called <a href="https://www.businesswire.com/news/home/20231130895945/en/Walgreens-Taps-RxSense-to-Power-%E2%80%9CRx-Savings-Finder%E2%80%9D-a-New-Digital-Marketplace-for-Prescription-Discounts" target="_blank" title="BusinessWire: Walgreens Taps RxSense to Power “Rx Savings Finder”, a New Digital Marketplace for Prescription Discounts">Rx Savings Finder</a>. Consumers who use the free service can save money on thousands of medications by comparing prices of free third-party discount prescription cards.</p><p>Customers can visit <a href="https://walgreens.rxsense.com/" target="_blank" title="Walgreens Rx Savings Finder homepage">walgreens.rxsense.com</a> via desktop or mobile devices, type in their prescriptions and perform searches. This will generate a list of prices from a variety of prescription savings services. Users can then click on the lowest-cost coupon and either text, print it or show the card via their phone to a Walgreens pharmacist for immediate savings of up to 80% off the retail price of prescriptions. The savings cannot be combined with or applied to prescription drug insurance.</p><p>RxSense also offers SaaS solutions for pharmacy benefits administration.</p><p>An 11-month pilot program between Walgreens and RxSense found that the new program saved customers nearly $70 million on their prescriptions compared with the cash price, according to one report.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 12 Dec 2023 06:00:00 -0600 Drug Price Transparency /news/headline/2023-04-18-report-most-hospitals-health-plans-posting-machine-readable-price-transparency-data <p>About 84% of hospitals had posted a machine-readable file containing rate information by the end of first-quarter 2023, up from 65% the previous quarter, according to a <a href="https://turquoise.health/impact_reports">report</a> released by Turquoise Health. The report also found that 183 commercial health insurers representing over 95% of U.S. commercially insured lives were publishing machine-readable files of their in-network negotiated rates and out-of-network allowed amounts, up from 68 in July 2022.</p> <p>Under the Centers for Medicare & Medicaid Services’ price transparency rules, hospitals have been required since January 2021 to publicly post a machine-readable file containing a wide range of rate information, among other requirements; while commercial health plans have been required since July 2022 to release machine-readable files of their in-network negotiated rates and out-of-network allowed amounts.  </p> Tue, 18 Apr 2023 16:03:00 -0500 Drug Price Transparency /aha-center-health-innovation-market-scan/2023-04-18-mark-cuban-lays-out-more-details-about-how-hes-disrupting-drug-pricing <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/Mark-Cuban-Lays-Out-More-Details-about-How-He-s-Disrupting-Drug-Pricing.png" data-entity-uuid="aa8fc663-902a-4b0a-b1dc-cfd881d1360f" data-entity-type="file" alt="Mark Cuban Lays Out More Details about How He’s Disrupting Drug Pricing. Mark Cuban headshot." width="100%" height="100%"></p><p>It’s no secret that billionaire Mark Cuban has his mind and assets focused on disrupting drug pricing in the U.S. But during a recent talk, Cuban shared new information about what his Cost Plus Drugs company is doing with payers and pharmacists.</p><p>Cuban shared the following information that raised some interesting questions earlier this month at the <a href="https://www.beckershospitalreview.com/hospital-management-administration/10-exclusives-mark-cuban-told-beckers-in-april.html" target="_blank" title="Becker's Hospital Review: 10 exclusives Mark Cuban told Becker's in April">Becker’s Hospital Review conference</a>:</p><h2><span>Engaging CMS</span></h2><p>Cuban said the company has been in talks with the Centers for Medicare & Medicaid Services (CMS) about Medicare drug pricing and sent CMS a price list on April 3. Generic specialty drugs like imatinib, which is used to treat some cancers, were discussed. Last June, a study published in the Annals of Internal Medicine showed that CMS could have saved up to $3.6 billion in generic drug costs if the program paid the same prices as Cuban’s online drug company.</p><h2><span>Moving Beyond Generics</span></h2><p>Cost Plus Drugs is looking to expand its reach beyond generics. Although Cuban's company now has 1,100 generics, it only has four name-brand products. Cuban made it clear he wants to add more name-brand drugs in all areas but controlled substances and specialty drugs not cleared for mail orders.</p><h2><span>Expanding Patient Access</span></h2><p>The company is trying to broaden patient access to mail-order drugs via an affiliated network with independent pharmacists and retail grocery chains. Patients would be able to pick up their prescriptions at local outlets rather than having to order their scripts by mail.</p><h2><span>Collaborating with Payers</span></h2><p>Cuban's company continues to pursue more collaborations with payers after its initial payer venture with Capital Blue Cross. Capital members can use their insurance cards on the Cost Plus Drugs website and be reimbursed or put the cost toward their deductible, if eligible, by submitting a claim.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" data-entity- type="file" width="721" height="130" class="align-center"></a></p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 18 Apr 2023 07:41:49 -0500 Drug Price Transparency /news/headline/2023-02-15-cms-test-new-models-lower-drug-costs <p>The CMS Innovation Center will test three new models to see whether they lower high drug costs, the Centers for Medicare & Medicaid Services <a href="https://www.cms.gov/newsroom/press-releases/hhs-secretary-responds-presidents-executive-order-drug-prices">announced</a> yesterday. The Medicare High-Value Drug List Model would encourage Part D plans to offer a low, fixed co-payment across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs that treat chronic conditions, CMS said. Under the Cell and Gene Therapy Access Model, which would begin development in 2023 and could launch as soon as 2026, state Medicaid agencies would assign CMS to coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies. Under the Accelerating Clinical Evidence Model, CMS would develop payment methods for Part B drugs approved under accelerated approval, in consultation with the Food and Drug Administration, to encourage timely confirmatory trial completion and improve access to post market safety and efficacy data, the agency said. </p> <p>Health and Human Services Secretary Becerra, who selected the models in response to a recent executive order, also directed the center to evaluate three other potential models for future implementation. For more on the models, their implementation and timelines, see the <a href="https://innovation.cms.gov/data-and-reports/2023/eo-rx-drug-cost-response-report">HHS report</a>. <br />  </p> Wed, 15 Feb 2023 16:01:00 -0600 Drug Price Transparency