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The AHFS DI is one of several compendiums [1] approved by the Social Security Act (Section 1861(t)(2)(B)(ii)(I)) as a source of off-label anti-cancer drug use. [2] [3] It was originally published in 1959 as the American Hospital Formulary Service (AHFS) by the American Society of Health-System Pharmacists.
Top Dollar Program (TOP$)SM is the State Medicaid Pharmaceutical Purchasing Pool started by Provider Synergies, for Louisiana and Maryland in 2005. Delaware, Idaho, Nebraska, Pennsylvania and Wisconsin joined more recently for a total of seven participants as of April 2009.
It also provides access to Medicaid enrollment for low-income Marylanders. Enrollment started on October 1, 2013. [1] As of the 2019 calendar year, 156,963 people were enrolled in private health plans, 39,720 people were enrolled in stand-alone dental plans, and 1,076,175 people were enrolled in Medicaid through Maryland Health Connection. [2]
MA grew from almost zero in 1998 to 33.8 million subscribers in 2024, or 55% of Medicare recipients. 98%+ were enrolled in a zero-premium MA-PD plan (including prescription drug coverage). [5] In 2022, 295 plans (up from 256 in 2021) covered all Medicare services, plus Medicaid-covered behavioral health treatment or long term services and ...
The first replication sites received Medicare and Medicaid waivers. [3] 1994. The National PACE Association (NPA) was formed. [3] 1997. The Balanced Budget Act of 1997 (P.L. 105–33, Section 4801-4804) established PACE as a permanent part of the Medicare program and an option under state Medicaid programs. [2] 2005-2006
[1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. [3] Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. [4] Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries. [5]
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Starting in fiscal year 2024, 50 drugs with the same criteria as before would need to have their price negotiated. Any newly approved, single-source, brand name drugs that exceeds a price threshold that the HHS has set that was determined to likely to meet the spending criteria. The negotiated drug prices would have to meet the following criteria: