Lawmakers Want Speedy Medicare Reimbursement for Breakthrough Devices
Posted in Regulatory and Compliance by mthibault on April 25, 2016
Legislators propose a bill to reduce the time it takes to secure Medicare reimbursement for innovative medical technology.
Congress has focused in recent years on easing the regulatory burden for medical device makers. But since reimbursement hurdles often outweigh regulatory or funding challenges as the top concern for the medtech industry, it's fitting that legislators are also trying to tackle delays in Medicare coverage.
A bill titled, "To amend titles XVIII and XIX of the Social Security Act to ensure prompt coverage of breakthrough devices under the Medicare and Medicaid programs, and for other purposes," was recently proposed before the House of Representatives. Its sponsors want to shorten the time period between FDA approval and Medicare reimbursement coverage.
This legislation would give new medical technologies that had received FDA approval automatic three-year Medicare coverage under the New Technologies Add-on Payment (NTAP) mechanism, according to a press release. At the end of those three years, CMS would re-examine the technology for permanent coverage.
BCBS of Michigan embraces electronic prior authorization
Exec explains what insurer learned in pilot project
April 26, 2016 | By Katherine Moody
A project at Blue Cross Blue Shield of Michigan offers valuable lessons for the healthcare industry's transition to electronic prior authorization (ePA), according to a Managed Healthcare Executive article.
The current prior authorization process includes paper, phones and faxes, which is a highly inefficient way for physicians to give patients authorization for selected prescription drugs and medical procedures, write James R. Lang, BCBSM's vice president of pharmacy, and Anthony J. Schueth, CEO of consulting firm Point-of-Care Partners. Moving from this antiquated process to an electronic one is easier said than done, but despite the challenges, ePA is gaining momentum, they say.
Recognizing its own need to move from a manual PA system to an ePA, BCBSM created a pilot program to leverage available technology for its medical specialty drug management program.