Learn how to use Uber, Lyft and other ride-sharing services!  Register now for a free AARP webinar Nov. 18.

Reply
Valued Social Butterfly
0
Kudos
156
Views

Re: Current CMS Administrator is Working for YOU !

156 Views
Message 1 of 3

@Snoopy48 wrote:

Who negotiates the lower drug prices?

 

If it is Medicare, why don’t all hospitals and patients get the benefit of lower prices?

 

If it is the hospital, how did they arrive at the 22.5% figure and is it reasonable? If the hospital is doing the negotiation they might be better off paying more for the drugs rather than participating in this program.


The only ones doing that now are Insurance Cos., Drug Chains (Wal Mart), some hospitals might, VA. Medi Care can not. If Medi Care could you would see lower drug costs. Do not be fooled by long posts referring to all kinds of places etc. In the real world it is not happening. One way or the other you will pay until Medi Care can deal with the drug cos. like the VA does.

Report Inappropriate Content
0
Kudos
156
Views
Valued Social Butterfly
0
Kudos
173
Views

Re: Current CMS Administrator is Working for YOU !

173 Views
Message 2 of 3

Who negotiates the lower drug prices?

 

If it is Medicare, why don’t all hospitals and patients get the benefit of lower prices?

 

If it is the hospital, how did they arrive at the 22.5% figure and is it reasonable? If the hospital is doing the negotiation they might be better off paying more for the drugs rather than participating in this program.

Report Inappropriate Content
0
Kudos
173
Views
Valued Social Butterfly
0
Kudos
189
Views
2
Replies

Current CMS Administrator is Working for YOU !

189 Views
Message 3 of 3

The "340B Drug Pricing Program.” is a Medicare program which allows qualified hospitals to buy drugs from the manufacturers at significant discount, while still getting Medicare Part B reimbursements at 6 percent above the average sales price. It’s a system designed to help certain institutions “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services,” according to its online description. Only some institutions benefit, including those treating a high volume of low-income patients or those operating in underserved or rural areas.

 

So they (these eligible hospitals) get an increased discount from the drug manufacturer and ALSO a 6% rebate above the average sales price from Medicare Part B -

 

A new federal rule finalized Nov. 1 is scheduled to take effect Jan. 1 which would dramatically reduce drug reimbursement rates for hospitals in this program.  The new policy would cut the reimbursement rate for drugs bought under 340B to 22.5 percent below the average sales price, erasing the cushion many eligible hospitals use to cover uncompensated care, fund research and support outreach, according to news reporting.

 

According to some eligible hospitals, they will have to reduce money in other areas to make up for the loss of this amount - The change could possibly disproportionately hit institutions like cancer centers, because they use some of the most expensive drugs and treat a relatively high concentration of Medicare patients.

 

Eligible Hospitals call the amount, received from Medicare Part B program, a savings but it is only applicable to certain hospitals.

 

Several health care providers and related health associations are challenging the new rule in court, making some rather scarey threats and conclusions, but unless stopped by something, the rule is set to go Jan.01, 2018. They say this is unlawful.  Hearing is set for 12/21 in D.C. court.

 

The Centers for Medicare & Medicaid touted the rule change as a way for Medicare beneficiaries to benefit from the discounts hospitals get on drugs. CMS will use the estimated $1.6 billion it saves in drug reimbursements to cover an increase in payments to all hospitals that perform certain covered outpatient services.  So ALL hospitals would get a boost in clinical care pay.  But the currently eligible hospitals say it is not nearly enough to offset the corresponding losses.

 

Some hospitals are exempted from this Medicare reimbursement changes for patients based on where they live - (sole) rural community hospitals.

 

Per CMS:  the Hospital Outpatient payment rule will lower out-of-pocket drug costs for people with Medicare and empower patients with more choices. Both rules finalized today increase access to care. Importantly, the Hospital Outpatient rule takes steps to preserve access in rural communities.

 

So what this does is lower the cost of these Part B medication FOR THE BENEFICIARY - cancer drugs or other  - they can then go to their choice of Medicare accepting facilities to get their treatment rather than just to these hospitals that hold the eligibility now.

 

CMS Press Release - 11/01/2017 - CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Incr...

 

. . . . . Medicare is taking steps to lower the costs Medicare patients pay for certain drugs in the hospital outpatient setting. Medicare beneficiaries would benefit from the discounts hospitals receive under the 340B Program by saving an estimated $320 million on copayments for these drugs in 2018 alone,” said Seema Verma, Administrator of CMS.

 

In the Hospital Outpatient Prospective Payment System (OPPS) final rule, CMS is helping to lower the cost of prescription drugs for seniors and other Medicare beneficiaries by reducing the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B Program. The savings from this change will be reallocated equally to all hospitals paid under the OPPS. Children’s hospitals, certain cancer hospitals, and rural sole community hospitals will be excepted from these drug payment reductions for 2018.

 

Personally, I think, Seema Verma, Administrator of CMS.is one very smart cookie and will help out everybody on Medicare to get the best treatment for the best cost (our cost and the governments' cost).

 

So what say you - if you have cancer and are getting outpatient treatment, would you rather have a lower cancer treatment drug (copay) cost and be able to get care at the Medicare accepting facility of your choice rather than at a place they tell you you have to go with this place getting the (your) discount on the cancer drug?

* * * * It's Always Something . . . Roseanne Roseannadanna
Report Inappropriate Content
0
Kudos
189
Views
2
Replies
cancel
Showing results for 
Search instead for 
Did you mean: 
Users
Announcements

Open Enrollment: Oct 15-Dec 7, 2019 Find resources to help you decide on the best healthcare insurance plans for you during Open Enrollment season

Top Authors