Medicare and Prescription Drug Prices

This briefing featured presentations by our experts highlighting the trends in Medicare regarding prescription drug pricing, and panelists discussed an array of policy options to align drug prices with value through alternative payment models.






Assessing Innovations in Medicaid

Medicaid is testing numerous new alternative payment and delivery system models to enhance the coordination of the health care services provided to millions of low-income Americans. This briefing examined the range of Medicaid’s efforts to improve care and promote value, including integrating health with non-clinical and behavioral services, creating managed care organizations, and instituting regional care collaborative organizations. Our panel also addressed Medicaid’s role in managing emerging issues such as the opioid epidemic and the spread of the Zika virus.






High-Need, High-Cost Patients: Challenges & Promising Models

Health systems have applied many innovative new strategies for improving quality and reducing costs when it comes to care for high-need, high-cost patients, who typically have multiple chronic conditions. Which of these innovations show promise, and what can we learn from them?






MACRA: Stakeholder Considerations and Next Steps

The Centers for Medicare & Medicaid Services (CMS) recently closed the public comment period for its proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA). This means that Medicare will soon change its payment system for physicians, and there could be broad implications for physicians, health systems, health plans, consumers and others.






Briefing for Reporters on MACRA & Medicare Payments

The Centers for Medicare & Medicaid Services (CMS) closed on June 27 the public comment period for its proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). This means that Medicare will soon change its payment system to emphasize value over volume, and physicians caring for Medicare patients will need to make decisions about how to adapt their practices to the new incentives.






Biosimilars in the United States: Next Steps

With biosimilar biological products moving from the lab to the marketplace, key policy and regulatory questions are being actively debated, with important implications for industry, patients, and the health care system.






Value-Based Pricing for Prescription Drugs: Opportunities and Challenges

Recent pharmaceutical innovations offer unprecedented possibilities for curing, treating, or preventing a range of diseases. However, patients, providers and payers alike have raised concerns about the affordability and sustainability of these drugs. As a response to price increases of both single-source and generic drugs, some stakeholders are calling for a move towards basing payments on value, and some payers and pharmaceutical manufacturers are exploring ways to base payments on outcomes. However, many challenges remain.






Medicare Payment System Reforms: What Do We Know?

Medicare is testing new ways to pay for medical services, emphasizing value rather than volume, and evidence is beginning to build about successes and challenges. This briefing will examine what we know so far about the basic models, savings, quality, the impact on patients and the prospects for replication.






Briefing for Reporters on State Health Initiatives

A governor met with reporters Friday, February 19 to discuss the latest health care innovations and changes they are pursuing or implementing. Gov. Asa Hutchinson, R-Ark., discussed his experience with the state’s program to move newly eligible Medicaid beneficiaries to qualified health plans, and his intentions for changes moving forward.






Health Care Consolidation: What You Need to Know

A top Federal Trade Commission official, along with key experts, met with reporters Dec. 15 to discuss the recent surge in health care consolidation; the driving forces behind this trend; and the implications for policymakers and enforcers.






Health Care Consolidation: Trends, Impact and Regulation

In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This briefing will discussed the driving forces behind this recent increase in consolidation; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.






Taking the Right Meds at the Right Time: Medication Adherence, Health Outcomes and Costs

Evidence shows that medication adherence—the extent to which a person takes medications as prescribed by their health care providers—is associated with improved health care outcomes for many costly chronic conditions, including heart disease, diabetes, and asthma. However, only 50% percent of Americans are estimated to take their medications as prescribed, and non-adherence is estimated to result in added direct and indirect costs to the healthcare system of over $300 billion per year. The challenges and policy questions surrounding medication adherence affect Medicare, Medicaid, and the private sector – and offer a window into broader questions surrounding the ability of our health care system to coordinate care, particularly for people with multiple chronic conditions. In this briefing, top experts from the public and private sectors explored key policy, practical, and research questions surrounding medication adherence and management of medications.






High-Need, High-Cost Patients: The Role of Behavioral Health

Behavioral health conditions, including mental health issues and substance use disorders, affect nearly one in five Americans and account for $57 billion in health care costs annually. This briefing discussed current initiatives to integrate behavioral and physical health care services in order to improve quality of care and reduce overall health care costs.






Prescription Drug Costs: Trends and Tradeoffs in the Pipeline from Lab to Market

Innovative drugs have brought about significant progress in treating costly and complex conditions. While there is agreement among many stakeholders that some of these breakthrough drugs have had a positive impact on Americans’ health and life expectancy, increasing prices have also caused some confusion about the methods by which drug prices are determined. The goal of this briefing was to discuss recent prescription drug price trends, as well as demystify the pricing process. It identified contributors to the rising prices of many drugs, including shareholder interests and R&D costs, in addition to explaining possible future pricing-related challenges for manufacturers, providers, and consumers.






Biosimilars Toolkit: Unpacking Complex Issues

The Alliance for Health Reform has released a new toolkit, “Biosimilars: Unpacking Complex Issues.” The Affordable Care Act created an expedited licensure pathway for biosimilars, and, in March 2015, the U.S. approved the first biosimilar, leaving policy makers, regulators, providers and stakeholders to grapple with regulatory and financial questions.

21st Century Cures: Can Congress Come Together?

Join us for a special breakfast for reporters, where former FDA Commissioner Andrew von Eschenbach will give you the latest on the fast-moving 21st Century Cures legislation. Karen Riley, deputy director of strategy at the FDA’s Office of External Affairs, will also be available to answer questions. The briefing comes just a week after the House Energy and Commerce Committee unveiled bipartisan draft legislation. The committee may begin voting on the measure as early as next week.






Improving Health Care Delivery: Innovation in the Private and Public Sectors

This event examined innovative efforts in both the private and public sectors to move toward a health system that is more patient-centered, cost-efficient and delivers better outcomes. It will address efforts underway at the Center for Medicare and Medicaid Innovation (CMMI) and other federal agencies to spur innovation and prioritize a shift toward higher quality care, as well as the progress made by the private sector in improving quality and reducing costs through innovation.






Health Care Costs: What You Need to Know

The briefing explored the trends in health care costs in both the public and private sectors. It explained recent moderate growth rates, along with possible reasons and prospects for the future. This session was especially helpful to congressional staff members new to the issue, but also served as a useful review for anyone working on health care policy.