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APPLIED POLICY INSIGHT
New regulations for discarded drugs
Effective January 1, the companies which manufacture certain drugs in single dose containers and the providers who administer them are subject to new regulations specific to discarded drugs.
 
The regulations stem from the Centers for Medicare & Medicaid Services’ (CMS’s) implementation of the 2021 Infrastructure, Investment, and Jobs Act, which requires manufacturers of single-dose or single-use containers of certain medicines paid for through Medicare Part B to provide refunds with respect to certain discarded amounts.

As providers adjust to the use of a new coding modifier, many drug manufacturers are preparing to provide refunds to CMS.

All interested parties are looking to a CMS town hall to be held in February for discussion of exceptions that may be made for certain drugs because of “unique circumstances.”
Where has your pharmacist gone?
If you’ve had a prescription filled in the last year, you won't be surprised to learn that the United States is facing a shortage of retail pharmacists. Across the nation, customers are finding their local pharmacy closed, sometimes for newly specified lunch hours, sometimes for weeks, and sometimes forever.  

It is more than an inconvenience. The pharmacist shortage can have life or death consequences. A little over a year ago, the Board of Trustees of the American Pharmacists Association (APhA) sounded the alarm that “Pharmacist burnout (has) hit breaking point, impacting patient safety.” 

But, if $75,000 sign-on bonuses aren't enough to entice a pharmacist to your corner drugstore, what might?
PAMA required cuts and reporting delayed until 2024
In a welcome development for the laboratory industry, on December 29, 2022, President Biden signed the Continuing Appropriations Act of 2023 which instructs the Centers for Medicare & Medicaid Services to suspend for one year the implementation of the next round of price cuts to the Medicare Part B Clinical Laboratory Fee Schedule (CLFS) called for under the Protecting Access to Medicare Act (PAMA). 
Opposing goals? Reconciling health equity and value-based purchasing
Two decades ago, value-based purchasing (VBP) and health equity were emerging concepts in healthcare, largely unknown outside of policy conversations or schools of public health or health administration.

Today, they are driving principles in American healthcare. But some are asking if they are oppositional goals and, if so, how the two can be reconciled.

Now that CMS has affirmed its commitment to "Advance Equity" as the first pillar in its strategic plan, how will it redefine risk adjustment in VBP?
What healthcare headlines await us in 2023?
Join the Northern Virginia Health Policy Forum on Wednesday, February 15 from Noon to 1:00pm ET, as we host three veteran Washington-based reporters in a discussion of the healthcare headlines we can expect to see in 2023. 

Our panelists will be:

  • Julie Appleby, senior correspondent for Kaiser Health News, who reports on the implementation of healthcare law, healthcare treatments and costs, trends in health insurance, and policy affecting hospitals and other medical providers.

  • Maya Goldman, who covers health policy issues as a reporter for Axios. Goldman focuses on health policy issues in Congress and the federal agencies, including Medicare payment, telehealth, and price transparency.

  • John Wilkerson, Washington correspondent for STAT, who writes about the politics of healthcare. In his more than 20 years of covering healthcare payment and regulation, Wilkerson has extensively covered policies that impact prescription drug prices.
Highlights from the January NVHPF webinar
On Wednesday, January 11, Applied Policy Senior Vice President John Voorhees hosted experts in hospice and palliative care for a discussion of Hospice Help Before You Need It: A Better Way to Deliver Home Care at the January meeting of the Northern Virginia Health Policy Forum.

Panelists included Edo Banach, formerly CEO of the National Hospice & Palliative Care Organization; Tonya Saffer, Division Director, Healthcare Payment Models, CMS Innovation Center; and Catherine Hamel, Executive Vice President of Continuing Care and President of Gilchrist Hospice Care based in Hunt Valley, Maryland.

The event emphasized "hope and cope" over "doom and gloom" as participants considered options for the provision of whole-person interdisciplinary palliative care before hospice care.

Watch highlights below or click the link to watch the event in its entirety.
On our calendars
Under review/On the docket
Applied Policy is paying particular attention to the following rules under review at the Office of Management and Budget:

  • CMS: Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
  • OSHA: Occupational Exposure to COVID-19 in Healthcare Settings

See all rules under OMB review here.
From the headlines
Insight Joke of the Month for January
How is medicine packaged for astronauts?
January's book recommendation
In The Contagion of Liberty: The Politics of Smallpox in the American Revolution, Andrew M. Wehrman vividly illustrates that America’s health policy debates predate America’s founding.

At the outset of the Revolutionary War, American colonists were also battling a smallpox epidemic. Wehrman, an associate professor of history at Central Michigan University, recounts how Americans accepted, embraced, and finally demanded inoculation against the disease and how General George Washington came to his decision to order the inoculation of the entire Continental Army.

Foreshadowing today’s discussions of health equity, Wehrman examines the debates over access to inoculation for the poor and enslaved Blacks. “Although inoculation had been introduced to Americans by an enslaved African,” Wehrman writes, “White Americans claimed the miraculous procedure as their own, and often kept it from people with dark skin.”
 
The Wall Street Journal called The Contagion of Liberty, “a deeply researched and gracefully written volume." And students of American history will be fascinated by the "cameo" appearances throughout, including Paul Revere violating quarantine and a young John Adams describing his inoculation to his beloved Abigail.

Published by Johns Hopkins University Press, The Contagion of Liberty is not yet available in paperback but is available as an audiobook and ebook for those of us who enjoy our books in non-traditional formats.
Applied Policy, L.L.C., is a health policy and reimbursement consulting firm strategically located minutes from Washington, D.C.