Associated Press Oct. 30, 2020 Open Enrollment 2020: What to Know The coronavirus pandemic is adding an extra layer of complexity to the already confusing health care sign-up period. Here are eight policy changes that could make a huge impact in 2020. “The challenge I anticipate we’ll see is around industry agreement on an approach that ensures the consumer sees the benefit of reduced healthcare costs.”, 4. International reference pricing for therapies paid for by Medicare. Keith Loria is a contributing writer to Medical Economics. “If Medicare were to move in the direction of the Pelosi proposal, in which drug prices would be indexed against foreign prices and the government would negotiate prices downward, we would expect that drug prices in the commercial market would fall as well,” Barrett says. HHS is aggressively pushing forward with new requirements to hasten the adoption of interoperable electronic health records and utilizing brand new legal authorities to do so. Related: Specialty Medications and Managed Care Pharmacy. “Insulins are biologic drugs, and they will be regulated as such for the first time in 2020. Emily Felder, senior policy advisor and counsel with D.C.- based Brownstein Hyatt Farber … For example, earlier this year, CMS announced five new primary care payment models designed to incentivize the entire healthcare system to transition to value-based care, especially for patients with complex, chronic, and high-need conditions. “The executive order describes the concept of price transparency as the means to creating a ‘shoppable’ experience-the idea that there could be packages of care at understandable, logical prices,” he says. “Not only will this force providers to package their care into ‘shoppable’ products for consumers, but it will also ultimately drive down prices through market forces.”. “The ETC as proposed extends to half of the Hospital Referral Regions [HRRs] in the country and includes the patients in the dialysis clinics in those HRRs and the nephrologists who work with patients in those clinics.”. Find background research. In its February 2019 Interoperability and Patient Access proposed rule, CMS requires all Medicare, Medicaid, and federal exchange plans to share claims data information electronically with enrollees. The resources below provide information about CDC offices and programs that focus on policy-related matters and on various laws, regulations, and policies that have public health … “Nobody will disagree on making it easier and more affordable for Americans to consume healthcare,” Hughes says. House Speaker Nancy Pelosi’s bill to lower prescription drug prices would save Medicare $345 billion over 10 years, according to a preliminary analysis from the nonpartisan Congressional Budget Office. Lee Barrett, executive director and CEO of Electronic Healthcare Network Accreditation Commission, the nonprofit standards development and healthcare accreditation company, says to the extent to which managed care companies manage drugs, as well as other healthcare service delivery, the current focus on bringing drug costs under control is relevant. John Nicolaou, healthcare expert at PA Consulting, a global healthcare consultancy with U.S. offices in New York, says the price transparency regulation proposal, started by executive order earlier in the year, and now part of a CMS proposed rulemaking, is currently in comment period. Sami Inkinen, CEO and founder of Virta Health, a San Francisco-based health tech company specializing in type 2 diabetes reversal through nutritional intervention, believes in 2020, there will be policy changes roll out to help address the rising cost of insulin, which the FDA Commissioner Scott Gottlieb, MD, has called unacceptably high for a decades-old drug. “While a political agreement on an approach to lowering drug prices will be difficult, we think there is a reasonable chance that drug manufacturers and PBMs [pharmacy benefit managers] will be squeezed considerably in 2020, and managed care organizations, like other payers/controllers of care, should benefit.”.
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