KHN Morning Briefing

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Medicare Payment Lobbying War Heats Up As More Voices Join The Fight

The campaigns center around a proposed 1.35 percent boost to Medicare Advantage. Kaiser Health News looks at how the Obama administration is trying to borrow ideas from the private sector with its Medicare plan, Medicare beneficiaries could face higher out-of-pocket drug costs as a result of the trend toward coinsurance rather than co-payments, and Rep. Pat Tiberi, R-Ohio, is urging his fellow lawmakers to consider changes to the Medicare Advantage program.

Politico Pro: Medicare Advantage Lobbying Fight Draws In New Players
The perennial brawl over billions of dollars in payments to private Medicare plans is bigger than ever. Even though the Obama administration is proposing an overall 1.35 percent boost to Medicare Advantage, health plans and diverse coalitions of Republican and Democratic lawmakers, employers and labor unions are rallying to fight policies within the program’s complex payment formula that could mean cuts to some health plans in 2017. (Demko and Cook, 3/17)

Kaiser Health News: How Medicare Drug Plans Hope To Follow Private Sector Lead
Aetna and Cigna inked deals in early February with drugmaker Novartis that offer the insurers rebates tied to how well a pricey new heart failure drug works to cut hospitalizations and deaths. If the $4,500-a-year drug meets targets, the rebate goes down. Doesn’t work so well? The insurers get a bigger payment. In another approach, pharmacy benefit firm Express Scripts this year began paying drugmakers a special negotiated rate for some cancer drugs — to reward the use of the medicines for the specific cancers for which they have the most demonstrated effectiveness. (Appleby, 3/18)

Kaiser Health News: Coinsurance Trend Means Seniors Likely To Face Higher Out-Of-Pocket Drug Costs, Report Says
Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee, a new analysis found. Fifty-eight percent of covered drugs in Part D drug plans are subject to “coinsurance” in 2016 rather than flat copayments, the analysis by Avalere Health found. The percentage of drugs requiring coinsurance has climbed steadily, increasing from 35 percent in 2014 to 45 percent last year. That percentage is approaching two-thirds of all covered drugs. (Andrews, 3/18)

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