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340B can be a powerful tool for healthcare equity by creating a ripple effect where drug savings for safety-net providers translate into expanded services and healthier communities. As technology to manage drug discounts bridges the gap between 340B and even MDRP, a more streamlined system could be effective in unlocking the program's full potential, allowing cost savings to flow directly to patients and fuel further progress in affordable care. #340B #Healthcare #MDRP

The 4/5 Healthcare Labyrinth is live. Click below to read. Major stories: -- Mark Cuban saves on drugs -- Biosimilar change allowed by CMS -- MTM criteria changes -- Oscar Health's success -- Great 2025 Medicare Advantage rule summary #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth

The 4/5 Healthcare Labyrinth is live. Click below to read. Major stories: -- Mark Cuban saves on drugs -- Biosimilar change allowed by CMS -- MTM criteria changes -- Oscar Health's success -- Great 2025 Medicare Advantage rule summary #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth

Great Article on Buy and Bill for those looking to build their skill set.

The Impact of the Inflation Reduction Act on Medicare Part D in 2025 The Inflation Reduction Act of 2025 is set to bring significant changes to Medicare Part D, focusing on prescription drug coverage to address rising healthcare costs. Here’s what beneficiaries can expect: 1. Adjusted Cost-Sharing: Beneficiaries may see changes in deductibles, copayments, and coinsurance to balance cost-sharing more equitably. 2. Restructured Coverage Phases: Expect refinements to the Initial Coverage Phase, Coverage Gap, and Catastrophic Coverage Phase thresholds and limits. 3. Direct Drug Price Negotiation: Medicare will negotiate drug prices directly with manufacturers to lower costs and improve affordability. 4. Enhanced Benefits: Look for expanded coverage options and improved access to preventive care and chronic disease management services. 5. Transparency and Quality Improvements: Measures will focus on clearer plan information, easier plan comparisons, and better understanding of drug pricing and coverage. The Inflation Reduction Act aims to strengthen Medicare Part D, making prescription drugs more affordable and accessible for beneficiaries while improving overall healthcare quality and transparency. We look forward to seeing how these changes work in practice.

Exploring the Ins and Outs of Buy-and-Bill: A Deep Dive into Provider-Administered Drugs. Our latest blog covers everything from the basics to best practices, offering valuable insights for healthcare providers and payers alike: https://lnkd.in/eE-_8_r4 #Healthcare #BuyAndBill #SpecialtyDrugs #PACS

🌟 Exciting Times Ahead for Medicare Part D! 🌟 As we approach monumental shifts in healthcare policy, Medicare Part D stands on the cusp of transformative changes. These modifications promise to reshape the landscape of prescription drug coverage, bringing both challenges and opportunities. Here's what you need to know: 🔍 **Increased Access:** The upcoming changes aim to widen access to essential medications. This is a vital step in ensuring every beneficiary can afford and access their prescriptions. The goal is to reduce out-of-pocket costs, particularly for those most in need. 💡 **Pricing Transparency:** One of the most significant shifts is the focus on transparency in drug pricing. These reforms encourage pharmaceutical companies and insurers to present clearer pricing structures. This will empower consumers to make informed decisions about their healthcare. 🛡 **Improved Coverage:** Expect enhancements in coverage options! New plans will offer a broader spectrum of medications and cater to the diverse needs of the community. This means more choices and potentially lower costs for different prescription drugs. ⚙️ **Changes in the 'Donut Hole':** The infamous “donut hole” is closing! Beneficiaries will experience more consistent coverage once they surpass initial limits. This change will ensure more predictable costs without sudden spikes in expenses through the year. 🚀 **Pharmacy Options:** The new policies will facilitate increased competition among pharmacies. End-users can now choose from a variety of service providers, stimulating competitive pricing plus innovative services. 🔸 **Enhanced Support for Chronic Conditions:** Special attention is being directed towards beneficiaries with chronic illnesses. Expect initiatives emphasizing preventive care and long-term management programs designed to improve quality of life while decreasing long-term costs. ✨ This period of transformation presents a golden opportunity for stakeholders to engage in dialogues about sustainable healthcare practices. At this crossroads, collaboration between providers, policymakers, and patients is more crucial than ever. Join the conversation by sharing your thoughts and experiences about these changes. What are you most excited about? How do you anticipate these reforms will impact you, or those in your care? Let's shape the future of Medicare Part D together! 💬 #HealthcareReform #MedicarePartD #PrescriptionCoverage #HealthcareInnovation

As part of the IRA, CMS has just released the projected savings for those with Medicare Part D coverage. This initiative offers visibility into the impacted drugs and costs for plan members. Although the newly negotiated prices will not take effect until 2026, the information provided is crucial for stakeholders to prepare for the upcoming changes. Most plans have insight into their own utilization and spend, but how do they compare in the market against their competitors? We have the claims data to provide an in depth analysis, down to the MSA. #Medicare #Healthcare #CMS #IRA #MedicarePartD #Savings

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This appears to create an upward pressure on Part B trend in 2025. The Medicare Trustees expect spending in 2025 to be $579.2B, with $244B or about 42% in Original Medicare. Physician administered drugs account for $25.8B of the FFS total. If Leqembi spending materializes at this level, it will increase Part B costs by ~0.6%. Since portions of Part B spending are not subject to co-insurance while Phys-Rx is, Medigap trend would increase by even more.