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Express Scripts Gets Discount On AbbVie's Hep C Rx; Covers It Without Restrictions

Express Scripts will only include AbbVie's hepatitis C drug Viekira Pak on its National Preferred Pharmacy formulary in exchange for a “significant” discount on the drug, an Express Scripts spokesman said, and there will be no restrictions to access for the 25 million people on that formulary.

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Congressional Medicare advisers worried health plans on Friday (Dec. 19) with talk of pay cuts by way of “increasing coding intensity adjustment.”

CMS Medicaid Chief Cindy Mann will leave the agency in late January after serving as the head of CMS' Medicaid and Children's Health Insurance Program for five years, the agency announced Friday (Dec. 19).

CMS added about 68,000 payment records to the Sunshine Act and Affordable Care Act's Open Payments database on Friday (Dec. 19).

Preliminary CMS data show that 9.7 million more people were enrolled Medicaid and CHIP at October's end than the average monthly enrollment from July to September 2013, although Connecticut and Maine were not included in that count.

Issuers must submit their qualified health plan (QHP) applications for participation in the Federally Facilitated Exchange starting March 16 through April 15, two months earlier than last year, and plan agreements will be signed by Sept. 15, a couple weeks before the planned Oct. 1 launch of open enrollment, CMS says in its draft 2016 letter to issuers that provides technical and operational guidance for issuers participating in the FFE.

The home health industry said it's too soon for Medicare payment advisers to determine whether home health pay cuts impede seniors from getting good care, even though the Medicare Payment Advisory Commission must report to Congress by year's end on the impact of rebasing on beneficiary access and quality of care.

FDA approved the second hepatitis C drug for use without interferon, called Viekira Pak, and AbbVie is charging $83,319 for a 12-week course of the drug, a company spokesperson said, compared to the $94,500 12-week price of Gilead Science's Harvoni and the $84,000 price of Harvoni's predecessor Sovaldi.

The federal DC District Court dismissed the American Hospital Association's lawsuit to compel HHS to turn around Medicare appeals decisions on time -- within 90 days at the third level of appeals -- and ruled that Congress and HHS should solve the problem, not the courts.