OVERVIEW (pp. 4-7)
*Current legislative status – p. 5
*Overview – p. 6
*Tools to expand coverage – p. 7
PRESCRIPTION DRUGS (pp. 8-20)
*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
INDUSTRY TAXES & FEES (pp. 20-23)
*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
ADDITIONAL PROVISIONS (pp. 36-47)
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