Coverage and Payment
Coverage and reimbursement shapes patient access and affordability. Life sciences companies rely on favorable coverage decisions to ensure market access and adoption of their products, while health plans need effective reimbursement strategies to manage costs and provide comprehensive benefits to their members.
Is Tiered Provider Reimbursement on the Horizon for Medicare Part B?
As policymakers explore opportunities to reform Medicare Part B, a tiered average sales price (ASP) add-on payment may be under consideration to align system incentives and curb spending.
Medicare Reimbursement of Virtual Care Delivery and Remote Monitoring
Beginning in 2019, CMS will reimburse for 5 codes relating to virtual care delivery and remote monitoring
Medicare Part B Payment Increases Will Offset 340B Drug Reimbursement Cuts for 85% of Hospitals
Rural hospitals will see an average 2.7% net increase of Part B payments.
New Analysis Identifies Factors That Can Facilitate Broader Reimbursement of Pharmacist Services
Pharmacists are increasingly providing direct patient care based on each state's scope of practice regulations in a variety of settings spanning inpatient, outpatient, and community pharmacies. Examples of these direct patient care services include immunizations, wellness and prevention screening, medication management, chronic condition management, and patient education and counseling. While opportunities for pharmacists to provide direct patient care services emerge, options for obtaining reimbursement for these services continue to be limited. Avalere Health assessed the current healthcare delivery and payment landscape to identify factors that can facilitate broader reimbursement of pharmacist services.