August 26, 2016

Looking Back, Moving Forward: The Weekend Edition for Saturday, August 27, 2016

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Welcome to the weekend, and thanks for checking in.

We’re bringing you the news from this past week as well as providing you with a look at the week ahead. 

Looking back, here are two big story we have been monitoring this week…

Affordable Care Act: Federal Upper Limits Now Updated 

The updated Affordable Care Act Federal upper limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the  Medicaid.gov website at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Pharmacy-Pricing.html

States will have up to 30 days from the Sept. 1, 2016 effective date to implement these updated FULs, according the Center for Medicaid and CHIP Services (CMCS), which posted the announcement on its website on Friday of this week.  

CMS Released New Prescription Drug Cost Data 

The Centers for Medicare & Medicare Services (CMS) has released privacy-protected data on the prescription drugs that were paid for under the Medicare Part D Prescription Drug Program in 2014.

This was the second release of the data on an annual basis. The data which shows which prescription drugs were prescribed to Medicare Part D enrollees by physicians and other healthcare professionals, according to CMS in a news release posted to its website. 

The 2014 data set contains information from over one million distinct healthcare providers who collectively prescribed approximately $121 billion in prescription drugs paid for under the Medicare Part D program. This represents a 17 percent increase compared to the 2013 data set. The March 2016 Department of Health and Human Services (HHS)  report provided a detailed analysis of prescription drug spending trends, and noted that overall prescription drug spending in the United States rose by 12.6 percent between 2013 and 2014. 

The 2014 data set describes the specific medications prescribed for 38 million Medicare Part D enrollees, who represent about 70 percent of all Medicare beneficiaries, CMS reported. The data set was created using information submitted by Medicare Advantage Prescription drug plans and stand-alone Prescription Drug Plans.

“With two years of data, it will now be possible to conduct analyses of trends from 2013 to 2014 as well as to conduct a wide array of analyses that compare prescribing habits for specific providers, brand versus generic drug prescribing rates, and state- and local-level differences in drug utilization and costs,” said CMS. “The 2014 data set includes new aggregated information on opioids, antibiotics, antipsychotics, and high-risk medications among the elderly. In addition, a prescriber enrollment status field has been added to indicate whether the prescriber is enrolled, not enrolled or opted out of the Medicare program.”

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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