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Blue Cross Blue Shield of Massachusetts (BCBS) last week announced it will cover naloxone — the opioid overdose reversal drug — as an over-the-counter medication, in today's bite-sized hospital and health industry news from the District of Columbia, Maryland, and Massachusetts.
- District of Columbia: The National Committee for Quality Assurance (NCQA) announced it will update its Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for health insurance companies in 2024. Specifically, NCQA intends to change HEDIS to encourage more precise gender- and sex-related interventions, including better aligning screening recommendations for transgender patients by, for example, encouraging insurers to include transgender people in preventive screenings for cervical and breast cancer. NCQA is also removing language from eight HEDIS measures that use gender to determine screening eligibility, according to Rachel Harrington, senior research scientist of health equity at NCQA. (Hartnett, Modern Healthcare, 8/30)
- Maryland: CMS last month reported the Medicare Shared Savings Program (MSSP) saved the agency $1.8 billion in 2022, marking the sixth consecutive year the program has saved CMS money and the second highest savings year on record since MSSP started. CMS also said accountable care organizations had higher performance on some clinical quality measures than other clinician groups outside of its program. (AHA News, 8/25)
- Massachusetts: BCBS of Massachusetts last week announced it will cover naloxone — the opioid overdose reversal drug — as an over-the-counter medication. Naloxone will soon be available over-the-counter, however many health insurers have not yet clarified whether they will cover the medication and reimburse patients for it. The American Medical Association has issued a call for insurers to cover naloxone over-the-counter, citing aspirin and vitamin D as other over-the-counter medications that insurers reimburse patients for. "Waiving out-of-pocket costs for this emergency medication aligns with our commitment to ensuring our members have access to the substance use disorder treatment they need, when they need it," said Sandhya Rao, BCBS' CMO, "especially critical as opioid-related overdose deaths in Massachusetts continue to rise." (Facher, STAT, 8/31)
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