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The HPC is currently accepting applications for:
- Policy Director, Health Care Transformation and Innovation
- Program Associate, Strategic Investment
- Program Assistant, Office of Patient Protection
- Digital Content Coordinator, Office of the Chief of Staff
- HPC Internship Program
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Hospital Mergers In New Hampshire
(NHPR, May 30, 2019)
Sen. deMacedo Sponsoring Neonatal Program to Assist Substance Exposed Newborns
(Cape Cod News, May 22, 2019)
Senate leaders unveil $42.7B budget
(SHNS, May 8, 2019)
Fight surprise medical bills with transparent protections
(Boston Globe, April 17, 2019)
Bid to stem health spending is test of the Delaware Way
(Delaware Business Times, April 5, 2019)
State group wants to urge hospitals, insurers to lower spending faster (BBJ, April 4, 2019)
Health spending slows, but pharmaceuticals drive new costs, health policy chief says (
Worcester Telegram,
March 15, 2019)
HPC data: Mass. residents spend more than $4000 annually on insulin
(Boston Herald,
March 14, 2019)
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Public Meeting Livestream
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Did you miss a public meeting? The HPC records all public sessions and broadcasts them live on our YouTube Channel, where you can view recordings of past meetings.
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Be sure to
visit our website
and follow us on Twitter to get the most timely information.
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Market Oversight and Transparency (MOAT) and Care Delivery Transformation (CDT)
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Yesterday, the
HPC's policy committees
met to discuss several research and program-related topics.
Materials, including the slide presentation, can be found here.
Video can be viewed on the HPC's YouTube Channel.
During the Market Oversight and Transparency (MOAT) Committee meeting, commissioners reviewed program updates for the MA-Registration of Providers (RPO) program, a first-in-the-nation initiative for collecting public, standardized information on Massachusetts' largest health care providers annually. 2018 filings from provider organizations are now available on the
HPC's website
. The online submission platform is now open for provider organizations to submit their
2019 filings
, which are due July 31, 2019.
Commissioners then discussed the design for the HPC's upcoming study on the impact of prescription drug coupons, discounts, and other product vouchers on pharmaceutical spending and health care costs. The HPC recently held a public listening session and received written testimony from eight organizations, available
here
. Commissioners reviewed other HPC publications including the latest
DataPoints issue,
as well as key findings and recommendations from an HPC report on the practice commonly referred to as white and brown bagging:
A
Review of Third-Party Specialty Pharmacy Use for Clinician-Administered Drugs
.
The report is expected to be released later this month.
During the Care Delivery Transformation (CDT) Committee meeting, commissioners reviewed two new publications: the ACO Program Policy Brief #3 and the
Tele-Behavioral Health Implementation Guide
. Commissioners then discussed MassUP, a new interagency project
aimed at upstream interventions to align population health and community health initiatives. The vision of MassUP is better health, lower costs, and reduced health inequities - across communities and populations in Massachusetts - through effective partnerships between government, health care systems, and communities to address the social determinants of health. Part of the program will include a competitive grant opportunity funded by the HPC for two community collaboratives to align social determinants of health investments.
Commissioners also reviewed an
update on the HPC's relationship with MassChallenge HealthTech (MCHT). In September 2018, the HPC entered a partnership with the digital health accelerator, with the goals of promoting community-based providers' access to digital health solutions and identifying digital health tools that may address high-priority policy areas. Commissioners then examined emerging findings from the HPC's ongoing evaluations for the CHART and Health Care Innovation Investment (HCII) programs.
To conclude the meeting, r
epresentatives from Holyoke Medical Center (HMC) presented commissioners with a look into their HPC-funded SHIFT-Care Challenge program aimed at enhancing access to treatment for opioid use disorder (OUD), which is now in its implementation phase. HMC's program engages with patients with OUD who present in the emergency department (ED), inpatient or outpatient settings, or are identified in local courts and jails. The primary aim is to reduce ED visits by 20% for the target population compared to baseline through an 18-month program totaling $750,000 of HPC grant funds.
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HPC DataPoints Gains State and National Attention with a Focus on Pharmaceutical Drug Spending
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New Analysis Highlights Need for Transparency in Drug Pricing Practices of Pharmacy Benefit Managers
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Yesterday, the HPC released its 12th
DataPoints issue, "Cracking Open the Black Box of Pharmacy Benefit Managers (PBMs)," which
examines PBM pricing practices for generic drugs in both the MassHealth Managed Care Organization (MCO) program and the commercial market. PBMs manage prescription drug benefits for health plans, including the negotiation of prices and rebates with manufacturers and payments to pharmacies. "Spread pricing" refers to the practice in which the PBM charges a payer more than it reimburses the pharmacy for a certain drug and retains the difference. This practice is used as a means of payment for PBM services but is less transparent and may allow for higher PBM profits than alternative methods. Spread pricing contrasts with the "pass-through model," where PBMs charge payers the same amount that they reimburse pharmacies, plus a set administrative fee. By industry estimates, the share of PBM revenue from spread pricing has grown from 22% in 2014 to 54% in 2016.
In the
2018 Cost Trends Report
,
the HPC issued a recommendation that the Commonwealth increase state oversight of pharmacy benefit manager pricing practices and take steps to limit the practice of spread pricing. The research released yesterday illustrates the opaque and convoluted flow of health care dollars throughout the drug distribution chain and highlights the inflationary impact that the practice of spread pricing may have on drug prices. The HPC concludes that greater transparency in the PBM drug pricing model is needed so payers can make more informed choices about allocation of state spending or premium dollars, including appropriate compensation for both pharmacies and PBMs.
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Key Findings:
- In the MassHealth program, average MCO/PBM drug prices in 2018 Q4 were higher than the acquisition prices for 95% of the unique drugs analyzed by the HPC and exceeded fee-for-service (FFS) prices for 42% of unique drugs.
- For the drugs where the MCO/PBM price was higher than the FFS price, the difference was often substantial, leading to higher average drug prices overall. MCO prices exceeded fee for service prices by an average of $15.97 per unique drug.
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For several widely prescribed generic drugs, a drop in acquisition costs has not translated to lower prices for the MassHealth MCO program. For example, from 2016 Q1 to 2018 Q4, the average acquisition cost for Buprenorphine fell by 60% while the MCO/PBM price increased by 13%.
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In the commercial market,
PBM prices for generic drugs were markedly higher than the drugs' acquisition costs. In 2016 Q4, average commercial price was higher than the acquisition prices for 72.3% of the unique drugs analyzed.
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The commercial PBM price for generic Gleevec, used in treatment of leukemia, was an average of $1,811 more per prescription than the pharmacy acquisition cost. This per prescription difference translated to more than $278,000 in aggregate spending above acquisition cost.
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Massachusetts along with other states and federal regulators are pursuing action to increase oversight of PBMs to ensure that public dollars are spent efficiently at all points in the drug distribution chain. A number of states have introduced legislation requiring PBMs to be licensed by the state and to disclose information on pricing, rebates and reimbursement to pharmacies, among other actions.
"These findings reinforce the urgent need for policy action to enhance the transparency and accountability of the prescription drug market," said
David Seltz, HPC Executive Director
.
Stay tuned for more from
HPC DataPoints
in the coming months. As you read through
DataPoints
, we encourage you to engage with the interactive graphics by hovering your mouse over different data points to obtain additional information. The graphics display best within Internet Explorer.
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New Care Delivery Insights
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ACO Brief #3 and a Tele-Behavioral Health Guide
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The HPC also recently published a Tele-Behavioral Health Implementation Guide, which is a new resource from HPC awardees on how to successfully implement tele-behavioral health services. This guide includes key insights and quotes from providers, covering four key areas of teleBH program development: workflow, data and measurement, workforce, and technology.
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Upcoming 2019 Public Meetings
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Board meetings are held at 12:00 PM unless otherwise indicated. On Committee meeting days, Market Oversight and Transparency (MOAT) meets at 9:30 AM and is immediately followed by Care Delivery Transformation (CDT) at 11:00 AM. All public meetings are held at the HPC's offices at 50 Milk Street in Boston, unless otherwise indicated.
Board Meetings
Wednesday, July 24
Wednesday, September 11
Monday, December 16
Committee Meetings
Wednesday, October 2
Wednesday, November 20
Advisory Council Meetings
Wednesday, July 10
Wednesday, November 13
Annual Cost Trends Hearing - Suffolk University Law School
Day 1 - Tuesday, October 22
Day 2 - Wednesday, October 23
Please note that these dates are subject to change over the course of the year, and more meetings may be added. Please check our
website for the most up-to-date information. A printable version of the 2019 calendar is available
here.
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