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245 Matching News Items
1.
PBMs: Impact on Employer-Provided Coverage Contract and Benefit Design (PDF)
America's Health Insurance Plans [AHIP]
May 9, 2024
America's Health Insurance Plans [AHIP]
May 9, 2024
"Given employer preferences for contracting flexibility and the importance of gainsharing contracts in reducing prescription drug spending, legislative proposals aimed at banning either spread pricing in the commercial market or variable rebate contracts restrict PBMs' ability to work with employers to design the plan that is right for their employees. With increased pricing transparency to plan sponsors, employers will be well-positioned to negotiate contract terms and select models that reduce prescription drug spending."
2.
Measuring the Sentiments of Individuals with Employer-Provided Coverage (PDF)
America's Health Insurance Plans [AHIP]
May 2, 2024
America's Health Insurance Plans [AHIP]
May 2, 2024
38 pages. "89% of survey respondents said their EPC has a provider network that includes options that are convenient for them.... One in five respondents reported using a cost comparison tool. Among those who did, almost 60% say it changed their behavior and some chose less expensive treatment options.... Most people were aware that their employer-provided plan covers preventative services at no out-of-pocket cost, but awareness varied by age, health status, and urbanicity."
3.
AHIP Letter to OCR on Cyber Breach Notification Obligations Following Change Healthcare Incident (PDF)
America's Health Insurance Plans [AHIP]
May 2, 2024
America's Health Insurance Plans [AHIP]
May 2, 2024
"At [the May 1 hearing] held by the House Energy & Commerce Committee, United CEO Andrew Witty said, 'we are offering to take full responsibility for all notification obligations for everyone involved in this.' [AHIP supports] this approach and agree that guidance from the Office of Civil Rights should clearly state that only Change has an obligation to perform breach notification in this context. That clarity would avoid tens of millions of Americans being left confused, frustrated and inundated by multiple notifications."
4.
Best Practices for Value-Based Care Payment Arrangements (PDF)
America's Health Insurance Plans [AHIP], The American Medical Association (AMA), and The National Association of ACOs (NAACOS
Apr. 24, 2024
America's Health Insurance Plans [AHIP], The American Medical Association (AMA), and The National Association of ACOs (NAACOS
Apr. 24, 2024
74 pages."VBC payment arrangements seek to align payment with performance on quality, cost, and patient experience.... [This playbook] identifies several voluntary best practices sourced from the direct experience of physicians, VBC entities, and health plans focused on alleviating pain points where possible to deliver better health and smarter spending for patients and communities."
5.
AHIP Letter to HHS Requesting Extension of Enforcement Discretion Under the No Surprises Act (PDF)
America's Health Insurance Plans [AHIP]
Apr. 21, 2024
America's Health Insurance Plans [AHIP]
Apr. 21, 2024
"AHIP is requesting ... that the Departments and OPM extend the exercise of enforcement discretion under the NSA beyond May 1, 2024, with the possibility of future extensions pending the release of further guidance, final resolution of still pending legal challenges or as may otherwise be appropriate. [This letter outlines] detailed explanations of many of the challenges health plans currently face as they seek to align their processes with the result of the TMA III decision."
6.
Analysis of the Impact on Health Insurance Premiums of Provider Markups on Specialty Drugs (PDF)
America's Health Insurance Plans [AHIP]
Apr. 18, 2024
America's Health Insurance Plans [AHIP]
Apr. 18, 2024
12 pages. "Consumers and employers will pay on average $50 more for single coverage and $175 more for family coverage in premiums in 2024 due to the markups charged by providers to supply specialty drugs that could have been supplied by a specialty pharmacy. The total value of health insurance premiums and premium equivalents that could have been saved if providers charged the same price for specialty drugs as those available from specialty pharmacies would be as much as $13.1 billion in 2024."
7.
AHIP Comment Letter to Agencies: Over-the-Counter Preventive Items and Services Available Without a Prescription (PDF)
America's Health Insurance Plans [AHIP]
Mar. 4, 2024
America's Health Insurance Plans [AHIP]
Mar. 4, 2024
15 pages. "[AHIP supports] the Tri-Departments' interest in increasing access to OTC preventive health care options, starting with OTC contraception, with appropriate guardrails. [AHIP's comments] emphasize the need for health insurance providers to promote access and affordability by directing them to preferred retail settings ... [and] provide recommendations on ensuring implementation places minimal burdens on consumers, providers, pharmacists, and health insurance providers."
8.
AHIP Comment Letter to CMS on Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (PDF)
America's Health Insurance Plans [AHIP]
Mar. 3, 2024
America's Health Insurance Plans [AHIP]
Mar. 3, 2024
54 pages. "AHIP has significant concerns that certain elements of the MA and Part D Advance Notice could diminish the value and affordability of the MA benefits that millions of seniors and people with disabilities count on ... As proposed, many of these changes included in the Advance Notice would lead to significant variability in the MA program across geographic markets ... In addition, plans are continuing the multi-year implementation of changes required under the Inflation Reduction Act (IRA), underscoring the impact of dynamic and uncertain market conditions facing beneficiaries and their coverage."
9.
No Surprises Act Continues to Prevent More Than 1 Million Surprise Bills Per Month, While Provider Networks Grow (PDF)
America's Health Insurance Plans [AHIP]
Jan. 18, 2024
America's Health Insurance Plans [AHIP]
Jan. 18, 2024
"[D]espite a high volume of claims being submitted to independent dispute resolution (IDR), the law's components appear to be working ... Health care providers typically accept the initial payment made by health insurance providers ... [T]wo-thirds of health insurance providers report their provider networks have increased since the NSA became law, with none reporting an overall reduction in participating providers."
10.
AHIP Comment Letter to CMS on Proposed Regs for Federal Independent Dispute Resolution Operations (PDF)
America's Health Insurance Plans [AHIP]
Jan. 3, 2024
America's Health Insurance Plans [AHIP]
Jan. 3, 2024
25 pages. "AHIP appreciates the Departments' interest in resolving communication issues throughout the IDR process and addressing the ongoing challenges for parties to determine accurate contact and plan information necessary to initiate and ultimately resolve a dispute. While well-intentioned to address these information-sharing challenges, the proposed IDR registry would likely not achieve its intended objectives."
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