The Health Policy War Room

Legislators and policymakers alike have struggled with finding effective ways to reconcile the differences between drug prices in the United States and prices for those same drugs in foreign countries. Many factors including Government price controls, varied supply chains, and differences in the volume and mix of drugs prohibit the direct comparison of drug prices between countries. The concept of developing a price index to track differences in prices over time and across markets is not new. The Medicare program has used market basket updates – a form of price indexing, to keep growth in payments under its prospective payment systems from falling behind prices in the market.  However, the concept of a price index for drugs has not been widely recognized by policy makers. That was, until President Trump released his “American Patients First” (1) blueprint to lower drug costs . In the blueprint, President Trump urged the Department of Health and Human Services to take steps to “addr...

Automated multichannel chemistry (AMCC) tests are a subset of diagnostic tests that are focused on overall well-being. Testing analytes like glucose, cholesterol, potassium, trigylcerides and others is part of almost every doctor's visit. The 23 tests that are generally identified as AMCC tests are relatively simple in nature using basic testing methods and the simple nature of these tests is reflected in the amounts that Medicare pays for these tests. The average Medicare Clinical Laboratory Fee Schedule (CLFS) payment rates for these tests is just over $6.50 per test. Despite the low per-test payment rate, AMCCs are big business, accounting for $194 million in Medicare spending in 2018. Read on for more...  There has been alot said about Medicare payment for AMCC tests since the Protecting Access to Medicare Act (PAMA) reformed the CLFS. Part of the way PAMA was implemented required Medicare to set payment rates and make payments for individual tests as described by their bil...