Back grey arrow rt.gif
BUDGET EXACT LANGUAGE ON DRUG PRICING, $20 Mill for Prep, New Funding for HCV Screening/Care in HIV+ (I think its $9 mill)
  Budget of the United States Government, Fiscal Year 2017 contains the Budget Message of the President, information on the President's priorities, and summary tables.
Addressing the High Cost of Drugs
The Administration is deeply concerned about rapidly growing prescription drug prices, driven in part by the shift to specialty therapeutics, the slowdown in patent expirations, and challenges in measuring drug value. To address this issue, the Budget includes a package of proposals focused on Medicare, Medicaid, and drug price transparency.
on page 66......Lowering Medicaid Drug Costs for States and the Federal Government. The Budget includes targeted policies to lower drug costs in Medicaid. It provides States with a new, voluntary tool to negotiate lower drug prices through the creation of a Federal-State Medicaid negotiating pool for high-cost drugs. In addition, the Budget continues to support and build on previously proposed reforms to the Medicaid drug rebate program. These reforms enhance manufacturer compliance with rebate requirements, and improve access to medications. In addition, the Budget corrects and improves the ACA Medicaid rebate formula for new drug formulations, such as by exempting abuse deterrent formulations. These proposals are projected to save the Federal Government approximately $11.4 billion over 10 years.
on page 66 ......Increasing Transparency of Prescription Drug Pricing and Ensuring Access to Generic Medications. The Budget proposes to provide the Secretary of HHS with the authority to require drug manufacturers to publicly disclose certain information, including research and development costs, discounts, and other data as determined through regulation. It also includes three previously proposed reforms designed to increase access to generic drugs and biologics by stopping companies from entering into anti-competitive deals intended to block consumer access to safe and effective generics, by awarding brand biologic manufacturers seven years of exclusivity, rather than 12 years under current law, and by prohibiting additional periods of exclusivity for brand biologics due to minor changes in product formulations. These proposals would save the Federal Government $21 billion over 10 years.
on page 65......Improving Quality and Lowering Drug Costs for the Medicare Program. The Budget includes proposals to lower drug costs while improving transparency and evidence development in the Medicare Part D program. The Budget proposes to increase data collection to demonstrate the effectiveness of medications in the Part D program in the Medicare population and to inform real world clinical treatment. The Budget continues to provide the Secretary of HHS the authority to negotiate drug prices for biologics and high-cost drugs in Medicare Part D and includes a new proposal to incentivize Part D plan sponsors to better manage care provided to beneficiaries with high prescription drug costs. To help ensure access and affordability of treatments, the Budget proposes to accelerate discounts for brand name drugs for seniors who fall into Medicare's coverage gap by increasing manufacturer rebates from 50 percent to 75 percent in 2018. In addition, the Budget proposes to require drug manufacturers to provide rebates generally consistent with Medicaid rebate levels for drugs provided to low-income Part D beneficiaries.
Together, these proposals would save Medicare approximately $140 billion over 10 years. on page 64.......Strengthening HIV and Hepatitis C Services. The Budget expands access to HIV prevention and treatment activities for millions of Americans through the continued implementation of the updated National HIV/AIDS Strategy, with a focus on three key elements of the Strategy. First, the updated Strategy calls for providing more people with highly effective prevention services such as pre-exposure prophylaxis (PrEP) to reduce new HIV infections. PrEP has been shown to reduce the risk of HIV infection by up to 92 percent in people who are at high risk. The Budget also includes $20 million for a new innovative pilot program to increase access to PrEP and allow grantees to use a portion of funds to purchase treatment and other health care services as the payer of last resort.
Second, the Strategy calls for improved screening for Hepatitis C, which disproportionally affects Americans living with HIV. The Budget includes funding for a new initiative to increase screening and expands access to Hepatitis C care and treatment among people living with HIV. Third, the Strategy calls for prioritizing HIV/AIDS resources within high-burden communities and among high-risk groups, including gay and bisexual men, Blacks/African Americans, and Latino Americans, which is reflected throughout the Budget.
15 things for healthcare leaders to know about Obama's 2017 budget......
Obama's 2017 budget proposal: What it means for payers
$4 trillion plan includes Medicare Advantage changes, Cadillac tax tweaks, policies aimed at curbing drug costs
February 9, 2016 | By Leslie Small
President Barack Obama unveiled his 2017 fiscal year budget Tuesday, including a host of provisions set to impact both public and private payers.
In the health insurance realm, the $4 trillion budget proposal would:
• Give any state that expands its Medicaid program three years of full federal support, regardless of when the state chooses to expand. "This commonsense proposal makes expansion as good of a deal for states that choose to expand now, as states that have already done so," according to a fact sheet about health-related budget proposals.
• Implement policies to improve care for Medicare-Medicaid dual-eligibles, including: creating an integrated appeals process for dual-eligible beneficiaries; simplifying the process for receiving Medicare Savings Program benefits; and making sure low-income individuals who are newly-eligible for Medicare have Part D coverage during their transition between payers and plans.
• Expand Medicare Advantage plans' ability to deliver services via telehealth and enable rural health clinics and federally qualified health centers to qualify as originating telehealth sites under Medicare.
• Create a competitive bidding system for Medicare Advantage that reforms payments based on estimates for the cost of beneficiaries' care; preserve most beneficiaries' access to a Medicare Advantage plan that provides supplemental benefits without requiring them to pay an additional premium; and provide higher payments to high-quality Medicare Advantage plans to encourage quality improvement.
• Limit the portion of Medicaid and Children's Health Insurance Program managed care dollars spent on administration and incentivize more investments in quality healthcare services by establishing a medical loss ratio of 85 percent.
• Adjust how the Cadillac tax works, including: making the threshold above which it applies equal to the greater of the current law threshold or the average premium for a marketplace gold plan in each state; making it easier for employers offering flexible spending arrangements to calculate the tax; and requiring the Government Accountability Office to conduct a study of the potential effects of the tax on firms with unusually sick employees.
• Create policies aimed at curtailing drug costs, including: providing the secretary of the Department of Health and Human Services with the authority to require drug manufacturers to publicly disclose information including research and development costs, discounts and other data; and providing states with a new, voluntary tool to negotiate lower drug prices through the creation of a federal-state Medicaid negotiating pool for high-cost drugs.

  iconpaperstack View Older Articles   Back to Top