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Drug Coverage Proposal

Improvements in the cost of medications for Medicare-eligible customers may not be too far off. The Centers for Medicare and Medicaid (CMS) has proposed some new ways to lower drug costs for those in the Medicare program, and with drug coverage through a stand-alone prescription drug plan or with a Medicare Advantage plan that includes drug coverage.

One provision in the proposal targets e-prescribing and would require the person’s plan “to adopt a provider Real Time Benefit Tool by the start of 2020.

“‘RTBTs have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit, which can improve medication adherence, lower prescription drug costs, and minimize beneficiary out-of-pocket costs,’ CMS stated.

Another provision of the CMS proposal is that drug coverage Explanations Of Benefits (EOBs) that people receive from their plans will be tasked with including drug pricing information and lower cost therapeutic alternatives as part of these EOBs to give customers the information in hand that can also potentially help them lower their out-of-pocket costs for their particular medications.

This is not a comprehensive list of the provisions of the CMS proposal which could become a set of new rules in the near future. However, we do want to get info about these two particular provisions out there, so everyone can have confidence in any changes to come and know there will be tangible things for American households coming that can help lower their drug costs.

Source: Kyle Murphy, “HealthPayer Intelligence.”

New Hospital Rule in 2019

The hospital price transparency rule takes effect on January 1, requiring providers to publicize their rates for all items and services.

“Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care.

“The mandate stems from the 2019 inpatient and long-term care hospital prospective payment system (IPPS/LTCH PPS) final rule, released in August, in which CMS included the requirement for hospitals to update their public price lists at least annually.

“‘The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to be active healthcare consumers,’ CMS wrote…

“While hospitals can choose the format for presenting the data, as long as it’s machine-readable, the list must include all items and services provided by the facility, CMS stated.

“‘CMS encourages hospitals to undertake efforts to engage in consumer friendly communication of their charges to help patients understand what their potential financial liability might be for services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals,’ the agency said.”

Source: Jennifer Bresnick, “HealthPayer Intelligence”

Winter Workouts

Cold comfort

“In some ways, winter can offer benefits you don’t get in summer. For instance, cold weather may actually improve endurance, says Dr. Tenforde. “In colder temperatures your heart doesn’t have to work as hard, you sweat less, and expend less energy, all of which means you can exercise more efficiently.”

“Studies also have shown that exercising in cold weather can transform white fat, specifically belly and thigh fat, into calorie-burning brown fat.

“Plus, winter workouts help you get exposure to sunlight, which may help ward off seasonal affective disorder, a type of depression that some people experience during the winter months. While cold-weather exercise is safe for most people, if you have certain conditions, such as asthma or heart problems, check with your doctor to review any special precautions you need to take based on your condition or medications.” Source: Harvard Health Publishing. For more information Click Here.

Tech Tackles Alzheimers

“The foundering search for an Alzheimer’s cure is fueling a parallel quest by technology companies to help patients and caregivers cope with the disease. The quest is to help patients and family caregivers cope with the disease by using virtual reality software, robotics, and novel communication tools. The solution is not simply developing tools to manage patient symptoms, but to deliver better support to family caregivers who are collectively spending more than $500 billion annually to care for elderly relatives.

“‘If we do not support the role of family caregivers and value them in this process, there is nothing we can do to bend the cost curve beyond what we’re doing,’ said Thomas Riley, chief executive of Seniorlink, which developed a digital communication platform to help coordinate care for Alzheimer’s patients.

“Technology firms are also selling digital products to help patients: A company called Dthera Sciences has built a therapy that uses music and images to help patients recover memories. The product analyzes facial expressions to monitor the emotional impact on patients and discover the sounds and visuals that provide the greatest relief.

“Another firm, Ageless Innovation, has developed robotic cats and dogs that help to treat the depression and social isolation that so often afflicts people with Alzheimer’s. Ted Fischer, the company’s CEO, said Wednesday that research conducted by Pace University showed the products resulted in better patient outcomes across several measures, including a reduction in hospitalizations. “And it produces joy and meaningful connections for these patients,” Fischer said.

“The pharmaceutical industry has racked up a long list of failures in recent years, with many drug candidates following a similar narrative. A promising treatment in early-stage research turns out to be a flop in late-stage trials, putting investors, patients, and caregivers on a roller coaster that always ends in disappointment and a return to the drawing board.

“Fischer and other technology executives (have) said their products are neither panaceas nor substitutes for a hoped-for pharmaceutical breakthrough that could reverse or prevent the symptoms of the disease. But they also urged public and private funders to step up investments in technology solutions that, in the short term, represent the best option for patients and families.”

Source: STAT.