Beneficiaries pay more for biosimilars in Medicare Part D; Workers' out-of-pocket costs outpace health plan payments

> Under the current Medicare Part D rules, beneficiaries are likely to pay more for biosimilar drugs than for their biologic reference products--which could reduce savings in the overall Medicare program, according to a new report from Avalere. Report

> Some consumer advocacy groups are criticizing the Centers for Medicare & Medicaid Services for what they say is the agency's refusal to explicitly require qualified health plans to accept payments from groups such as charities and hospitals, Inside Health Policy reports. Article (subscription required)

> From 2004 to 2014, employees' out-of-pocket healthcare costs grew 77 percent, according to a new Kaiser Family Foundation analysis. That outpaced their health plans' average payment per enrollee, which rose by only 58 percent. Analysis

AntiFraud News

> A robust data analytics platform can pull out trends and patterns of potential fraud, but special investigative units also need to rely on "street smarts" to target fraudulent providers, according to Doug Cedras, former director of corporate and financial investigations at Blue Cross Blue Shield of Michigan. Article

> A centralized case management system has helped multiple departments within Kaiser Permanente coordinate fraud investigations using a standardized process, according to Marita Janiga, executive director of investigations with the National Compliance, Ethics and Integrity Office at Kaiser. Article

And finally… Hey, a guy's got to eat. Article

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