tci Medicare Compliance & Reimbursement - 2008 Issue 4

Part D: Part D Overhaul Focuses On Value, Comprehensive Coverage

Price fixation may become the norm Health policy researchers Ruth Lopert, BMed, MMedSc, and Marilyn Moon, PhD, recommended in a Commonwealth Fund-supported study that outcome assessments of the Part D benefit should emphasize data on therapeutic value rather than drug pricing alone. "A long-term objective should be integrating drug benefits with comprehensive health coverage," said researchers in the Dec. 3 Commonwealth Fund release. They advised that the Centers for Medicare and Medicaid Services (CMS) develop a comprehensive plan to compete with private plans. A CMS plan would require a comprehensive but closed formulary, built on transparent, evidence-based assessments...

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