CMS Considers Alternate Payment Models To Curb Costs On High-Price Treatments, Gene Therapy
“We are trying to do whatever we can to increase competition and give the (health insurance) plans more tools so that they can be better negotiators on our behalf,” Centers for Medicare and Medicaid Services chief Seema Verma tells Reuters. In other CMS news: The agency officially ends two mandatory bundled-payment models and Verma also comments on 1332 waivers.
Exclusive: U.S. Health Regulator Verma Eyes New Methods For Drug Pricing
The U.S. government is considering setting new payment methods aimed at curbing costs for Medicare and Medicaid coverage of breakthrough medical treatments with very high prices, particularly novel gene-based therapies for cancer and other diseases, a top health official said on Thursday. (Humer, 11/30)
CMS Makes It Official: Two Mandatory Bundled-Pay Models Canceled
The CMS has finalized its decision to toss two mandatory bundled-payment models and cut down the number of providers required to participate in a third. Only 34 geographic areas will be required to participate in the Comprehensive Care for Joint Replacement Model, or CJR, according to a rulemaking released Thursday. Initially, 67 geographic areas were supposed to participate. Up to 470 hospitals are expected to continue to operate under the model. (Dickson, 11/30)
Verma Says 1332 Waivers Are Too Restrictive, As States Seek Flexibility
Seema Verma, the head of the Centers for Medicare and Medicaid Services, said Thursday that her agency's ability to provide states flexibility and freedom from Affordable Care Act regulations is limited absent congressional action, casting doubt on the effectiveness of special ACA waivers. Some Obamacare opponents have hoped states could use 1332 waivers to fashion a more conservative health care system without running afoul of the law. (Goldberg, 11/30)