Price Transparency

Health Plan
Letters, Statements & Analysis

House Health Committees Hold Hearings with Health Insurer CEOs

On Jan. 22, the House Energy & Commerce Health Subcommittee and House Ways & Means Committee held hearings with the Chief Executives of five major health insurers. With a focus on affordability, Members and witnesses each shared a series of questions, proposals, and commitments regarding the increasing costs of care in the United States. And while health policy proposals continue to face partisan gridlock in Congress, legislators on both sides of the aisle agreed that health insurance premiums have risen exponentially, while increasing rates of prior authorization denials hamper patient access to care.
Price Transparency, Prior Authorization/Electronic Prior Authorization (ePA)
Resource

AMCP Submits Comments to CMS on Medicare and Medicaid Programs; Regulation to Require Drug Pricing Transparency

On January 25, 2019, AMCP provided comments to CMS in response to its proposed rule on lowering drug prices and reducing out-of-pocket expenses in the Medicare program. The letter outlines the proposal’s impact on providing plan flexibility to manage protected classes, prohibition against gag clauses in pharmacy contracts, E-Prescribing and the Part D Prescription Drug Program, Part D explanation of benefits, and Medicare Advantage and step therapy in Part B.
Legislation & Regulation, Fraud, Waste and Abuse, Medicare, Price Transparency, Medicaid, Medicare Part D
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AMCP Comments on CMS Medicare Program; International Pricing Index Model for Medicare Part B Drugs

On December 31, 2018, AMCP provided comments to CMS on its Advanced Notice of Public Rulemaking (ANPRM) for a potential International Pricing Index (IPI) Model for Medicare Part B Drugs. The potential model would be phased in over a five-year period starting in Spring 2020 and will be tested as a pilot program through CMMI. It also seeks to reform the current “buy and bill” system for Part B drugs and alter reimbursement methodology. AMCP shared its concerns that elements outlined in the ANPRM need further consideration to ensure that they are sustainable solutions for decreasing medication costs before making substantial changes to existing programs.
Legislation & Regulation, Price Transparency, Medicare Part B