Medicare Industry Insider

The Inflation Reduction Act of 2022 will have a massive impact on energy production, manufacturing, and even prescription drug prices for Medicare beneficiaries. Listen in as Rachel and Chalen go over the details.
 
Informational Sources:
- https://www.democrats.senate.gov/imo/media/doc/inflation_reduction_act_one_page_summary.pdf
- https://www.cms.gov/files/document/10522-inflation-reduction-act-timeline.pdf
- https://www.congress.gov/117/plaws/publ169/PLAW-117publ169.pdf
- https://www.fiercepharma.com/pharma/merck-applies-more-legal-pressure-against-ira-asking-decision-without-trial
- https://www.ssa.gov/OP_Home/ssact/title18/1860D-15.htm#:~:text=(3)-,Gross%20covered%20prescription%20drug%20costs,-.%E2%80%94For%20purposes
- https://www.kff.org/medicare/issue-brief/a-small-number-of-drugs-account-for-a-large-share-of-medicare-part-d-spending/
 
 
 
 

The Medicare Innovation Center is often the “test kitchen” for the world of healthcare and a catalyst for industry wide change. As an increasingly active Congress takes on urgent healthcare issues outside of Medicare—can the Medicare Innovation Center point us in the right direction?
 
Information Links:
- https://innovation.cms.gov/
- https://innovation.cms.gov/innovation-models/aco-reach
- https://innovation.cms.gov/innovation-models/making-care-primary
- https://innovation.cms.gov/innovation-models/vbid
- https://innovation.cms.gov/innovation-models/enhancing-oncology-model
- https://innovation.cms.gov/innovation-models/independence-at-home
- https://innovation.cms.gov/innovation-models/ahcm
- https://innovation.cms.gov/innovation-models/part-d-savings-model
- https://innovation.cms.gov/innovation-models/map

Telehealth services can offer convenient and speedy services, but are the benefits it promises greater than the risks it presents?
 
Informational Links:
- https://www.health.harvard.edu/staying-healthy/telehealth-the-advantages-and-disadvantages 
- https://hbr.org/2022/05/the-telehealth-era-is-just-beginning
- https://www.usatoday.com/story/news/health/2023/05/11/end-covid-public-health-emergency-explained/70182594007/ 
- https://www.usatoday.com/story/news/health/2023/05/09/dea-extends-covid-policy-telehealth-prescriptions-controlled-substances/70199984007/
- https://www.washingtonpost.com/business/2023/04/01/hospital-facilities-telehealth-fees/
- https://www.npr.org/2023/04/08/1168795014/telemedicine-was-supposed-to-reduce-costs-heres-why-thats-not-always-the-case
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744872/
- https://pubmed.ncbi.nlm.nih.gov/35767691/
- https://www.healthline.com/health-news/the-pros-and-cons-of-telemental-health-services#Knowing-when-online-mental-health-services-are-beneficial
- https://www.andrearowelltherapy.com/
- https://www.health.harvard.edu/staying-healthy/telehealth-the-advantages-and-disadvantages
- https://www.ruralhealthinfo.org/topics/health-information-technology
- https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers
- https://docs.fcc.gov/public/attachments/FCC-18-10A1.pdf
 

Over the years, the 340B pharmacy discounting program designed to help low income and uninsured individuals has grown to over $40 Billion in annual discounts, and now faces many challenges. Are program hospitals abusing their discounted access to drive profits? Are drug manufacturers and PBMs simply playing hardball? Find out more in this episode.
 
Informational Links:
- https://www.aha.org/fact-sheets/fact-sheet-340b-drug-pricing-program
- https://www.aha.org/system/files/media/file/2019/03/fact-sheet-340b-drug-pricinig-program-0119.pdf
- https://www.hrsa.gov/opa
- https://www.govinfo.gov/content/pkg/FR-2022-11-30/pdf/2022-25752.pdf
- https://www.foley.com/en/insights/publications/2023/03/future-340b-program-2023-key-decisions
- https://www.fiercehealthcare.com/hospitals/drug-makers-get-mixed-bag-lawsuit-rulings-over-340b-contract-pharmacy-moves
- https://www.aha.org/news/headline/2023-01-30-3rd-circuit-sides-340b-drugmakers-contract-pharmacy-case
- https://www.fiercehealthcare.com/hospitals/federal-judge-rules-hhs-efforts-to-punish-pharmas-over-340b-restrictions-arbitrary-and
- https://www.ncsl.org/health/state-options-for-managing-the-340b-drug-pricing-program
- https://340binformed.org/2021/05/more-states-acting-to-protect-340b-safety-net-hospitals/
- https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf
- https://documents.ncsl.org/wwwncsl/Health/PBMSnapshot_37424.pdf
- https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2018/06/how-correctional-facilities-could-lower-drug-prices
- https://nastad.org/sites/default/files/2021-11/PDF-340B-Viral-Hepatitis.pdf
- https://sao.texas.gov/reports/main/07-003.html
- https://etf.wi.gov/boards/wpcsc/2019/10/31/item3/direct
- https://www.statnews.com/2022/07/07/for-profit-pbms-diverting-billions-340b-savings/
 
 

Working within the Medicare population means your clients are at higher risk for cancer and may face challenges when getting the care that is most beneficial for them. It’s important for you to know what services are available to them and what is and is not covered by insurance. Make your cancer story one full of hope and health for those in your life. 
 
 
Cancer Resources:
https://www.medicare.gov/Pubs/pdf/11931-Cancer-TreatmentServices.pdf  
Colorectal Cancer Screenings: https://www.medicare.gov/coverage/screening-colonoscopies
Prostate Cancer Screenings: https://www.medicare.gov/coverage/prostate-cancer-screenings
Cervical & Vaginal Cancer Screenings Senior: https://www.medicare.gov/coverage/cervical-vaginal-cancerscreening
Mammograms: https://www.medicare.gov/coverage/mammograms  
Lung Cancer Screening: https://www.medicare.gov/coverage/lung-cancer-screening  
Preventive & Screening Services: https://www.medicare.gov/coverage/preventive-screening-services  
https://www.medicare.gov/coverage/prescription-drugs-outpatient#
 
Other Resources: 
CDC Cancer Media Resource Library:
- https://www.cdc.gov/cancer/dcpc/resources/index.htm
- https://www.cdc.gov/cancer/
American Cancer Society Cancer Facts & Figures 2020: https://www.cancer.org/research/cancer-facts-statistics.html
In-Depth Information Sheets: https://www.oncolink.org/treatment-binder
 
 
 
Informational Links:
- https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/ 
- https://www.cancer.gov/about-cancer/understanding/statistics
- https://www.cancer.gov/about-cancer/causes-prevention/risk/age#:~:text=Age%20and%20Cancer%20Risk,-Advancing%20age%20is&text=The%20incidence%20rates%20for%20cancer,groups%2060%20years%20and%20older
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051983/
- https://progressreport.cancer.gov/after/economic_burden
- https://health.usnews.com/best-hospitals/rankings/cancer
- https://www.medicare.gov/Pubs/pdf/02226-medicare-and-clinical-research-studies.pdf
- https://www.fightcancer.org/sites/default/files/National%20Documents/Costs-of-Cancer-2020-10222020.pdf
- https://www.medicare.gov/publications/11109-Medicare-Drug-Coverage-Guide.pdf
- https://www.medicare.gov/coverage/prescription-drugs-outpatient
- https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-coverage/drugs-excluded-from-part-d-coverage
- https://www.cms.gov/files/document/10522-inflation-reduction-act-timeline.pdf
- https://www.medicare.gov/coverage/prescription-drugs-outpatient
- https://www.kff.org/medicare/issue-brief/prices-increased-faster-than-inflation-for-half-of-all-drugs-covered-by-medicare-in-2020/
- https://www.kff.org/medicare/issue-brief/how-will-the-prescription-drug-provisions-in-the-inflation-reduction-act-affect-medicare-beneficiaries/
- https://www.medicare.gov/Pubs/pdf/10116-Your-Medicare-Benefits.pdf
- https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings
- https://www.hhs.gov/about/news/2023/04/03/hhs-releases-national-cancer-plan.html

With access to Long Term Care getting harder and more baby boomers aging, more people will find themselves in caregiver roles. Do your clients have a plan for care? 
 
Informational Links:
- https://www.agingcare.com/articles/daughters-care-more-for-parents-than-sons-171474.htm
- https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/
- https://www.aplaceformom.com/caregiver-resources/articles/women-and-caregiving
- https://www.caregiving.org/wp-content/uploads/2020/05/9NAC-Morhardt.pdf
- https://www.aplaceformom.com/caregiver-resources/articles/women-and-caregiving
- https://www.medicare.gov/Pubs/pdf/11376-discharge-planning-checklist.pdf
- https://eldercare.acl.gov/Public/Index.aspx
- https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Caregiver
 

Pharmacy Benefit Managers’ have been under more scrutiny than ever over their role in increasing prescription drug costs. Listen to this week’s episode for insight on whether PBM’s are still providing a necessary and valuable service, or if they have worn out their welcome. 
 
Informational Links:
- https://www.pcmanet.org/pharmacy-benefit-companies-101-a-primer/  
- https://content.naic.org/cipr-topics/health-insurance
- https://www.commonwealthfund.org/publications/explainer/2019/apr/pharmacy-benefit-managers-and-their-role-drug-spending
- https://www.fiercehealthcare.com/payers/senate-bill-aims-ban-pbm-practices-such-spread-pricing-and-boost-ftc-enforcement-powers  
- https://content.naic.org/cipr-topics/pharmacy-benefit-managers#:~:text=PBMs%20create%20formularies%2C%20negotiate%20rebates,manage%20mail%2Dorder%20specialty%20pharmacies
- https://www.fiercehealthcare.com/health-tech/mark-cuban-cost-plus-drugs-launches-billing-program-pharmacies  
- https://medcitynews.com/2023/04/express-scripts-launches-new-solutions-to-advance-drug-price-transparency/ 
- https://medcitynews.com/2023/02/pbms-come-under-fire-during-senate-hearing/
- https://medcitynews.com/2023/03/bipartisan-legislation-efforts-build-against-pbms/
- https://www.fiercehealthcare.com/payers/express-scripts-aims-boost-independent-pharmacists-rural-areas 
- https://www.prnewswire.com/news-releases/express-scripts-launches-new-initiative-to-expand-rural-health-care-access-through-partnerships-with-independent-pharmacies-301802608.html
- https://www.axios.com/2023/03/17/sanofi-insulin-price-cap-rebate-medicaid
- https://www.axios.com/2022/10/18/insulin-rationing-prices-study
- https://arstechnica.com/science/2023/03/heres-why-slashing-insulin-prices-will-actually-save-big-pharma-money/amp/
- https://arstechnica.com/science/2023/03/heres-why-slashing-insulin-prices-will-actually-save-big-pharma-money/amp/ 
 

For the last 10 years we have seen rural hospitals close at an alarming rate. This affects the client's ability to get routine comprehensive preventative care and critical care when needed. Listen for more details!
 
Informational Links:
- https://www.kff.org/health-costs/issue-brief/rural-hospitals-face-renewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/ 
- https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01478?journalCode=hlthaff
- https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/
- https://www.mhanet.com/mhaimages/advocacy/Missouri-Hospital_Closures_0120.pdf 
- https://www.aha.org/2022-09-07-rural-hospital-closures-threaten-access 
- https://www.komu.com/target8/target-8-records-show-noble-health-mismanaged-audrain-callaway-community-hospitals-for-years/article_1812b7c4-63bb-11ed-b2c6-cfe2efb29f33.html 
- https://www.kff.org/report-section/a-primer-on-medicare-how-does-medicare-pay-providers-in-traditional-medicare/ 
- https://khn.org/news/hospital-penalties/ 
- https://kffhealthnews.org/news/medicare-eases-readmissions-penalties-against-safety-net-hospitals/
- https://kffhealthnews.org/news/medicare-trims-payments-to-800-hospitals-citing-patient-safety-incidents/
- https://www.advisory.com/daily-briefing/2022/07/07/quality-reporting 
- https://www.advisory.com/daily-briefing/2022/04/20/cm-sipps
 
 

With CMS constantly moving the goalposts on marketing compliance, how can you use this newest set of guidelines to your advantage to remain relevant and in touch with your client base? Let's discuss tips and trends to get the most out of your marketing efforts!
 
Informational Links:
-https://www.marketwatch.com/story/why-medicaid-is-for-the-middle-class-4a2e79b0 
-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693352/  
-https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNF3DayRule-MLN9730256.pdf  
-https://innovation.cms.gov/data-and-reports/2023/snf-waiver-summary   
-https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/   
-https://medicareadvocacy.org/ma-plans-deny-care-even-as-they-claw-for-overpayments/  
- https://www.fiercehealthcare.com/hospitals/nursing-homes-snfs-facing-pandemic-labor-challenges-force-hospitals-to-delay-discharges 
-https://www.fiercehealthcare.com/hospitals/staffing-shortages-force-long-term-care-facilities-to-limit-admissions-hire-agency 
-https://www.medicare.gov/care-compare/resources/nursing-home/staffing 

Join us as we talk about skilled nursing care and the issues of access and affordability that Medicare beneficiaries face. We’ll address the challenges and pitfalls of skilled care and how you can better serve your clients.