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


Please see full e-Book below for full table of contents and more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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