Applied Policy and our team of experts are quoted/featured in the following:
Use of Copay Offset Programs Expected to Rise | AMCP Nexus
Ashley Gallagher, Managed Healthcare Executive, October 15, 2024
Another concern for employers is legalities and ethics of the programs. In the presentation, Alison Falb, JD, vice president of health policy at Applied Policy, said that copay accumulators have been the subject of rulemaking and lawsuits. For federal regulations, the Affordable Care Act, Notice of Benefit and Parameters (NBPP) and a joint legislation from the Departments of Labor, Health and Human Services and the Treasury all apply.
CMS Proposed ‘Monumental’ Digital Therapeutics Codes — What’s Next?
Christian Robles, Inside Health Policy, July 29, 2024
Still, CMS must answer several key questions that will determine if and how practitioners will be able to bill the proposed DMHT codes, Simay Okyay, senior health policy manager for Applied Policy, told IHP.
Okyay said Digital therapeutic companies should also clarify the necessary documentation required to bill the new codes. CMS also must clarify the criteria DMHT and DMHT patients must meet to be eligible for the Medicare coverage, Okyay said.
Navigating the Inflation Reduction Act’s Impact on Drug Pricing and Health Care
Dean Celia, First Report Managed Care, June 2024
To seek additional expert insights, First Report Managed Care connected with Gary Owens, MD, president of Gary Owens Associates (Ocean View, DE) and Alison Falb, health policy director at Applied Policy (Washington, DC). Dr Owens reported that “the way net cost is derived will determine formulary position. Follow the dollars. Plans need to find the best financial outcomes to maintain profitability.”
Ms Falb shared similar concerns stating, “There won’t necessarily be a one-size-fits-all approach. The [strategy] may change over time as more drugs have MFPs and new drugs enter the market…patient access to high list price and high rebate drugs may be retained, but there can also be negative impact on access to other drugs.”
Who Will Benefit Under the Medicare Part D Out-of-Pocket Spending Cap?
Dean Celia, First Report Managed Care, February 27, 2024
A KFF poll revealed that only 25% of older adults know the Part D provision. This does not surprise Alison Falb, health policy director, Applied Policy, Washington, DC. “Older adults are likely less aware of this provision because of [its] complexity. Details about the rollout, which looks different in 2024 than in 2025, and explaining how cap can lead to savings makes messaging more complicated.” Edmund J Pezalla, MD, founder and CEO, Enlightenment Bioconsult, Wethersfield, CT, concurred. “The cap seems straightforward but [will be] difficult for people to understand until it happens.”
Latest Formulary Exclusions from Top PBMs Demonstrate Issues in the Drug Pricing Landscape
Dean Celia, First Report Managed Care, February 21, 2024
Alison Falb, health policy director, Applied Policy, Washington, DC, noted that changes to the Medicare Part D benefit under the Inflation Reduction Act change the incentives that promote this behavior regarding Part D plans. “Plans will be responsible for a greater share of costs, including once a beneficiary has met their out-of-pocket cap. This may lead to Medicare plans favoring products with lower list prices.”
CBO underestimates Medicare Part D savings by $4 billion due to oversight lapse
Virgil Dickson, Modern Healthcare
In the Bipartisan Budget Act of 2018 the Congressional Budget Office underestimated the amount Medicare would save due to changes in Medicare Part D. The savings come from an increase in the government mandated discount that drug manufacturers must offer enrollees in the Medicare prescription drug coverage gap. However, this could impact drug prices long-term as manufacturers account for the mandatory discount as they determine prices for their new drugs.
Value of CMS’ voluntary bundled-payment program remains unclear
Virgil Dickson, Modern Healthcare
Research on the Bundled Payments for Care Improvement initiative is inconclusive and the cost and care value of BPCI remains unclear. Providers’ voluntary participation and multitude of options makes it difficult to measure outcomes.
Clearing Up Misperceptions Around the ACA’s Current Status
Christina Mattina, AJMC Managed Markets Network
At the AMCP 2017 Nexus meeting, a public policy expert argued that despite all of the news surrounding the Affordable Care Act (ACA), the US healthcare system may not see fundamental changes anytime soon.
Breaking Down the Current State of the ACA
David Costill, Managed Health Care Connect
Director of Health Policy outlined how the marketplaces are currently faring, how recent policy decisions by the Trump Administration will likely impact the market places, and the numerous legislative actions taken by Congress in 2017 related to the ACA. She notes that the marketplaces are not in as bad a shape as current media coverage suggests, and that the real dysfunction is more related to access.
Alliance for Aging Research Names James G. Scott Chair of Its Board of Directors
Noel Lloyd, Alliance for Aging Research
AAR introduces two new members to its Board of Directors, discussing their experience in the health policy community and thanking Jim Eden for his service.
CMS Sticks to Mandatory Pay Bundles, Despite Rep. Price’s Opposition
John Wilkerson, Inside Health Policy
The final rule maintains regulations on bundled pay demonstrations for cardiac and joint replacement services while also creating three new models and expanding the existing orthopedic program. CMS’ direction may change with the incoming Trump administration.
BPC Praises Draft Chronic Care Bill, National Coalition on Health Care Urges Quick Passage
Michelle M. Stein, Inside Health Policy
The chronic care discussion draft proposes a variety of reforms and balances some of the CBO’s concerns with those of political parties and special interests. The Bipartisan Policy Center and National Coalition on Health Care see this as an opportunity to produce constructive solutions to health care affordability challenges.
Testimony from James Scott
Senate HELP Subcommittee on Primary Health and Retirement Security Hearing
Coalition Backs Plan for Flexible Residency-Building Window
Joyce Frieden, MedPage Today
A coalition of medical societies and hospitals is supporting a new idea for boosting medical care in underserved communities: allowing medical schools in those areas to have a longer period of time to build up their residency programs.
Small Business Owners say Obamacare Flaws Making Insurance Expensive
Elizabeth Potter, Washington Examiner
Three small business owners told a Senate hearing Tuesday that Obamacare is riddled with problems that are leading to more expensive insurance policies, which is making it harder for companies to provide high-quality healthcare to their workers.
Hospitals urge CMS to broaden transitional Medicaid Managed Care Funds
Virgil Dickson, Modern Healthcare
Providers are asking the CMS to withdraw a rule that would block billions in supplemental funding that helps safety net and Medicaid providers care for their poorest patients.