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Health Policy

On October 26, 2017, leaders of the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced that they had reached an agreement to permanently repeal the annual limit on per-patient therapy expenditures in Medicare, often referred to as “therapy caps.”

ACR officials said the response originates from the CMS 2019 Benefit and Payment Parameters proposed rule, which governs the state and federal health exchanges created by the Affordable Care Act.

An increasing number of insurers are using step therapy protocols, which mandate that a patient try and fail 1 or more formulary-covered medications before providing coverage for non-formulary or non-preferred medications that were originally prescribed by the patient’s physician.

Dallas, TX— Insurance claims for individuals with rheumatoid arthritis (RA) accounted for a mean total cost of care 3.5 times higher than that of individuals without RA, with approximately 67% of the difference attributed to biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD) use, according to the results of a recent study presented via poster at the Academy of Managed Care Pharmacy Nexus 2017 Conference.

Two related studies have documented significant deficiencies in the way the FDA approves expanded or new indications for drugs, using its expedited approval processes with limited evidence.
Significant gains in cancer research and prevention have led to longer survival, improved quality of life, and decreased disease burden. The 2015 annual report on “Clinical Cancer Advances” from the American Society of Clinical Oncology (ASCO) outlines the biggest advances made in oncology, and for the first time designates one cancer as the Advance of the Year, as well as emphasizing the ongoing challenge of value-based care.
The recently released American Society of Clinical Oncology (ASCO) annual report, “The State of Cancer Care in America, 2015,” is a mixed bag: the report cites multiple advances in the progress against cancer, but also elaborates on the many hurdles in implementing state-of-the-art cancer care for all Americans.
Late last year, the American ­Society of Clinical Oncology (ASCO) issued a policy statement on Medicaid reform, with recommendations on ensuring quality of care for all patients with cancer, including the underserved population, while also improving provider reimbursement to ensure value-based care. ASCO’s poicy statement advocates for the expansion of Medicaid coverage to all Americans with cancer, an increase in Medicaid pay­­ment rates to reach those of Medicare, and a greater emphasis on rewarding providers for the delivery of quality care.
A survey of patients with cancer and caregivers about the benefits they would like Medicare to cover in their last 6 months of life uncovered large gaps with the benefits that Medicare currently offers.
The US Department of Health and Human Services (HHS) has responded to the chorus of voices calling for less complex rules governing electronic health records (EHRs) by not adopting the Voluntary 2015 Edition Electronic Health Record Certification Criteria. In its final rule, released in September 2014, the Office of the National Coordinator for Health Information Technology has instead included 10 optional and 2 revised certification criteria.
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