On June 24, 2019, President Trump signed an executive order, and Senators John Thune (R-S.D.) and Ben Carper (D-DE) introduced bipartisan legislation that allow health savings account eligible high-deductible health plans (HSA-HDHPs) the flexibility to cover essential medications and services used to treat chronic diseases prior to meeting the plan deductible.
Introducing V-BID 2.0: CMS Announces Updates to Medicare Advantage V-BID Demo January 18, 2019 - The Centers for Medicare and Medicaid Services (CMS) announced transformative updates to the Medicare Advantage Value-Based Insurance Design (MA V-BID) model. These changes aim to increase choice, lower cost, and improve the quality of care for Medicare beneficiaries. The model launched on January 1, 2017, and has since been expanded to include 25 states, 9 chronic conditions, Chronic Condition Special Needs Plans, and allows participants to propose their own systems or methods for identifying eligible enrollees. Riding on the heels of the Bipartisan Budget Act of 2018, which included a directive to expand the model to all 50 states by 2020, today's release makes sweeping changes to the CY2020 model, including: Allows plans to provide reduced cost-sharing and additional benefits to enrollees in a more targeted fashion Bolsters rewards and incentives programs that plans can offer beneficiaries to [...]
Press Release: V-BID Improves Medication Adherence Without an Increase in Total Health Care Spending
Basing patients' medication costs on the health benefits they'll get from a drug, rather than its price, means they're more likely to take it Excerpt from IHPI press release:"Taking a medicine every day in the hopes that it will prevent some long-range potential health catastrophe -- like a heart attack or kidney failure -- isn’t easy.Many people skip doses, or don’t refill their prescriptions on time, or at all. And plenty of studies have shown that the more patients have to pay for those prescriptions, the less likely they are to take them as directed.But new evidence shows the power of a method aimed at changing this behavior: insurance plans that charge patients less for the medicines that could help them most. Some plans even make some of the medicines free to the patients with certain conditions.In an article published in the July issue of Health [...]
Press Release: V-BID Highlighted at Two Congressional Hearings The Health Subcommittee of the Congressional Committee on Ways & Means and the Joint Economic Committee held hearings on lowering health care costs and expanding access to health care. Value-Based Insurance Design principles were highlighted at both hearings as a potential cost-saving, health-improving measure. June 6, 2018: Ways and Means Hearing on Consumer-Directed Health Plans "How do we lower costs and expand access to health care?" The Health Subcommittee of the Congressional Committee on Ways & Means held a hearing on lowering costs and expanding access to health care through Consumer-Directed Health Plans. Value-Based Insurance Design principles were highlighted as a promising reform to high-deductible health plans, particularly in chronic disease management and HSA rule flexibility. Matt Eyles, President and CEO of America’s Health Insurance Plans (AHIP), highlighted that HSAs should have more [...]
Trump Administration "American Patients First" Drug Pricing Blueprint Includes V-BID "Value-Based transformation of our entire healthcare system is a top HHS priority" On May 11, 2018, President Trump gave a speech introducing his administration's "American Patients First" drug pricing plan, which strongly reflected V-BID concepts. The 44-page blueprint includes lowering out of pocket costs, implementing value-based purchasing in federal programs (including indication-based pricing and long-term financing), instructing CMS to create demonstration projects to encourage value-based care and lower drug prices, and considering adjustments to HHS regulations regarding drug copay discount cards. "FDA also announced it will facilitate opportunities for enhanced information sharing between manufacturers, doctors, patients and insurers to improve patient access to medical products, including through value-based insurance." A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID Center, is available for questions or comments. View the [...]
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 email@example.com 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 [...]
New Alexander-Murray bipartisan bill includes V-BID Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached an agreement on Tuesday, October 17th regarding their bipartisan bill to fund key insurance subsidies. The cost-sharing reduction payments reimburse insurance companies for lowering deductibles, co-payments and other out-of-pocket costs for low-income customers. Page 11 of the draft bill language includes a section on value-based insurance designs: "(iii) waivers encouraging or requiring health plans in such State to deploy value-based insurance designs which structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services;" Value-Based Insurance Design (V-BID) is a potential solution built on the principle of lowering or removing financial barriers to essential, high-value clinical services and providers. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services. These innovative programs are designed with the tenets of clinical nuance in [...]