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Meeting the Opioid Challenge: Getting Naloxone to Those Who Need it Most In April 2018, the US Surgeon General recognized the gravity of the US opioid epidemic and issued a rare public health advisory calling for increased availability of naloxone. This policy explicitly acknowledges that naloxone—a rescue medication that temporarily reverses the effects of an opioid overdose—does not cure opioid addiction. However, by preventing immediate harms such as death, naloxone use offers the survivor an opportunity to enter treatment when ready.Unfortunately, national implementation of a policy aimed to enhance access to naloxone faces many practical barriers, including identifying those most likely to benefit, deciding how and where to distribute the medication, and ensuring affordability. Naloxone prices have increased markedly over the past few years and range between $20 for a generic vial to $4,500 for an easy to use auto injector. Separate from drug acquisition costs, high consumer out-of-pocket costs [...]

New Cms Rule Provides More Flexibility for V-BID Benefitsin Medicare Advantage On April 16, 2018, CMS officially published their new rule for the Medicare program contract year 2019.  This rule includes a reinterpretation of the Medicare Advantage (MA) uniformity requirement that will allow for more flexibility in benefit design for MA enrollees with specified chronic conditions.  CMS determined: Providing access to services (or specific cost sharing) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the Medicare Advantage (MA) regulationsBeginning in 2020, CMS will wave the uniformity requirement for MA plans that provide additional supplemental benefits to chronically ill enrollees.  This change paves the way for the further incorporation of V-BID principles into the Medicare Advantage program.  While the ongoing MA V-BID Model Test will continue, plans outside of [...]

On March 16, 2018, the President's Cancer Panel released a report to the President titled "Promoting Value, Affordability, and Innovation in Cancer Drug Treatment."  The report addresses the rising cost of cancer drugs and includes a recommendation for "value-based pricing and use of cancer drugs."  Such a recommendation aligns with the core principles of value-based insurance design and supports the V-BID Center's Precision Benefit Design initiative. PART 2: Taking Action to Promote Value, Affordability, and Innovation in Cancer Drug Treatment "V-BID may be well suited to cancer care due to the increasing role of high-cost specialty drugs and the growing capability to use biomarkers to match drugs with patients most likely to benefit.  Public and private payers should develop and test V-BID programs that promote patients’ use of high-value cancer drugs." (p.15) Specific recommendations made by the President's Cancer Panel to promote value-based pricing and [...]

Government Funding Bill Expands MA V-BID Model Test to All 50 States On February 9, 2018, President Trump signed the Bipartisan Budget Act of 2018.  The funding bill incorporates the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which includes the expansion of the CMMI Medicare Advantage Value-Based Insurance Design (V-BID) Model to all 50 states.  The model allows Medicare Advantage plans the flexibility to reduce cost-sharing or offer supplemental benefits to enrollees with specified chronic conditions, focusing on the services that are of highest clinical value to them. SEC. 50321: Adapting Benefits to Meet the Needs of Chronically Ill Medicare Advantage Enrollees."(h) National Testing of Medicare Advantage Value-Based Insurance Design Model-"(1) In General - In implementing the Medicare Advantage Value-Based Insurance Design model that is being tested under section 1115A(b), the Secretary shall revise the testing of the model under such section to cover, effective not later than January [...]

On Thursday, February 8th, 2018, Senators John Thune (R-SD) and Tom Carper (D-DE), and Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR), introduced the Chronic Disease Management Act of 2018 (S.2410 and H.R. 4978) in the House of Representatives and the Senate.  The bipartisan bill states,  "Allowing health savings account-eligible high-deductible health plans to cover chronic disease prevention and treatment on a pre-deductible basis promotes the concept of Value-Based Insurance Design, which is an effective tool to improve the quality and reduce the cost of care for Americans with chronic diseases, with improved outcomes via increased medication adherence, reduced complications, and decreased emergency department visits."The bill amends IRS Section 223 (c)(2)(C):(a) IN GENERAL—Section 223(c)(2) of the Internal Revenue Code of 1986 is amended by redesignating subparagraph (D) as subparagraph (E) and by inserting after subparagraph (C) the following new subparagraph: ‘‘(D) SAFE HARBOR FOR ABSENCE OF DEDUCTIBLE FOR [...]

New V-BID Center Video Details How Precision Co-Pay Assistance Programs Enhance Access to Clinically Indicated Therapies  Consumer cost-sharing for prescription drugs is high and getting higher.  To address the high out-of-pocket medication costs, patient assistance programs, such as co-pay cards, have become available to reduce consumers' financial liability.  However, the use of co-pay assistance for medications for which there is an effective, lower-cost alternative is deemed as financially burdensome to the healthcare system. To counteract this inefficiency, Accumulator Adjuster Programs - which prevent co-pay assistance funds from being applied to patients' deductibles - are increasingly being implemented, resulting in greater patient financial responsibility and potential disruption of recommended treatments. Our new "Precision Co-Pay Assistance Program" whiteboard video introduces a clinically nuanced solution designed to ensure access to clinically indicated therapies. V-BID Center Director, A. Mark Fendrick, MD, is available for questions or comments at vbidcenter@umich.edu or (734) 615-9635. [...]

  On November 30, 2017, the National Academy of Sciences, Engineering, and Medicine released a long awaited report on access and affordability of prescription drugs. The report, "Making Medicines Affordable: A National Imperative", includes a key recommendation to the   V-BID Center: Congress also should direct the Centers for Medicare & Medicaid Services to modify the designs of plans offered through Medicare Part D and government health insurance exchanges to limit patients’ out-of-pocket payments for drugs when there is clear evidence that treatment adherence for a particular indication can reduce the total cost of care, as determined by HHS. To read more about V-BID and Medicare Advantage, view the resources below.                                

CMS ANNOUNCES UPDATES TO MA V-BID MODEL TEST On November 22, 2017, the Centers for Medicare and Medicaid Services (CMS) announced updates to the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The model launched on January 1, 2017, at which time select MA plans in 7 states were permitted to offer varied benefit designs for enrollees diagnosed with specified clinical conditions.  In 2018, the model will expand to three new states and will add two clinical categories. Beginning in 2019, the V-BID model will expand to an additional fifteen new states for a total of 25 states, allow Chronic Condition Special Needs Plans to participate, and allow participants to propose their own systems or methods for identifying eligible enrollees.   The MA-VBID model test aims to assess the utility of structuring consumer cost-sharing and plan elements to encourage the use of high-value clinical services and providers for beneficiaries with specified [...]

Ann Arbor, MI -- If you've tried to see a doctor, fill a prescription or get a diagnostic test lately, you've probably had to pay more out of your own pocket than you would have even a few years ago. Most insurance plans have increased [...]