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MedPAC Sessions on Telehealth, PBMs and Specialty Pharmacies, and Post-Acute Care Discharges

Friday, September 8, 2017   (0 Comments)
Posted by: MaryBeth Wilkerson
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On September 7, 2017, the Medicare Payment Advisory Commission (MedPAC) convened a public meeting to consider issues including: (1) telehealth services and the Medicare program; (2) the role of pharmacy benefit managers (PBM) and specialty pharmacies; and (3) ways to encourage Medicare beneficiaries to use high quality post-acute care (PAC) providers.  There were no votes or recommendations presented during today’s sessions.  Telehealth issues will be examined extensively during the 2017/2018 meeting cycle, and the Commissioners indicated that they would also take-up PBM and specialty pharmacy issues and post-acute care discharge issues later this cycle as well.

 During the telehealth session, Commissioners stated support for identifying particularly high value telehealth services - such as mental health services and pharmacology management - and expanding coverage for these services in Medicare and Medicare Advantage (MA).  Commissioners also questioned the current restrictions on telehealth in MA, noting that the concerns that exist in fee-for-service Medicare - such as overutilization - do not exist in the capitated payment setting.  Commissioners also discussed other policies that may need to be addressed in the context of telehealth expansion, including licensing issues and how to assess whether telehealth is fulfilling unmet service needs or producing unnecessary utilization.  

 The pharmacy benefit manager (PBM)/specialty pharmacy session was intended to provide technical background on drug supply chain issues to the Commission.  Many Commissioners commented on the complexity of the issues raised during the presentation, including specialty drug coverage, direct remuneration reporting, and PBM ownership of specialty pharmacies, and suggested that some of these issues be examined separately in future sessions.  The Commission also discussed policy issues including the role of exclusive specialty pharmacy networks in Part D, PBM transparency rules, and whether MA prescription drug plans should manage specialty drugs that are under the medical benefit.

 Finally, in the post-acute care session, Commissioners discussed ways to better ensure beneficiaries are discharged to higher-quality PAC providers. There was general support for several policies, including allowing hospitals to directly recommend certain PAC providers to beneficiaries and expanding the use of PAC value-based purchasing programs.

Below are additional materials from these meetings:

MedPAC September 2017 Public Meeting Sessions

Telehealth Session

Specialty Pharmacy Session

This update was brought to you by The Coalition of State Medical Societies exclusively for LSMS members.

Representing physicians from coast-to-coast, the Coalition of State Medical Societies comprises 10 state medical associations with more than 180,000 physician and medical student members. Our collective challenges are to improve our system by making it more affordable and accessible for all Americans without sacrificing choice and quality of care. All members – blue and red – understand that we must be engaged in the process and offer solutions that protect these fundamental strengths of our healthcare system. To learn more about the Coalition, click here.



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