Health Reform: Patient Protection and Affordable Care Act & Health Care and Education Affordability Reconciliation Act: KEY PROVISIONS


OVERVIEW (pp. 4-7)

*Current legislative status – p. 5

*Overview – p. 6

*Tools to expand coverage – p. 7


*Closes the Part D Coverage Gap (Donut Hole) – pp. 9-10

*Increases Medicaid Rebate – p.11

*Revises the AMP Definition, and Limits Payments for Hospital-Acquired Conditions – p. 12

*Expands the Medicare 340B Drug Discount Program to New Covered Entities – p. 13

*Establishes a FDA Approval Pathway for Biosimilars – p. 14

*Generic Drugs: Medicaid Rebate & Part D Coverage Gap – p. 15

*Increases Medication Adherence through Part D Medication Therapy Management Programs – p. 16

*Codifies the Current Part D Protected Classes – p. 17

*Authorizes Study and Possible Regulations Requiring a Drug Facts Box – p. 18

*Increases Coverage of Prevention Services – pp. 19


*Establishes an Industry Fee on Pharmaceuticals – p. 21

*Taxes Medical Devices and Imposes an Annual Fee on Insurance Providers – p. 22

*Creates Employer Mandates and Taxes on High-Cost Plans – p. 23

PAYMENT REFORM (pp. 24-35)

*Establishes a Medicare & Medicaid Innovation Center within CMS – p. 25

*Creates an Independent Payment Advisory Board (IPAB) – pp. 26-27

*Implements a National Pilot Program on Payment Bundling – p. 28

*Rewards Accountable Care Organizations for Quality of Care and Reducing Costs – p. 29

*Extends Gainsharing Demonstration Project – p. 30

*Encourages Development of Medical Homes – p. 31

*Revises Drug Coding & Reimbursement – p. 32

*Modifies MA Payment Methodology – p. 33

*Impact on Physician Reimbursement – p. 34

*Modifies PBM Reporting – p. 35


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