AHA Sues On 340B Pilot
The American Hospital Association (AHA) has again sued a federal regulator to block the second 340B rebate pilot, set to begin January 1. Hospitals say it will cost them more than $1 billion because the regulation underestimates labor hours and implementation expenses. The first pilot was struck by a court. The government issued a second regulation. All 340B covered entities will be in the pilot for certain in-scope drugs. Studies suggest the facilities do not pass on discounts to needy Americans. The suit seems like a stretch, but who knows what will happen in a post-Chevron legal world.
#340b #drugpricing
https://www.modernhealthcare.com/politics-regulation/mh-aha-hrsa-340b-rebate-pilot-lawsuit/
Stars Results Details
More news on the 2027 Medicare Advantage (MA) Stars front since Thursday’s release. I will have a deep-dive blog on Monday. Humana, which suffered a major ratings collapse two years ago, saw its percentage of members in 4+ Star plans skyrocket to 95% in 2027. That could mean $3 billion or more in extra revenue in 2028.
In other news, healthcare policy group KFF says one in five Medicare beneficiaries (20%) can choose from more than 40 MA Part D plans for coverage in 2027.
KFF also has nice briefers on MA open enrollment and Medicare enrollment and costs.
Additional article: https://www.modernhealthcare.com/insurance/mh-medicare-advantage-star-ratings-unitedhealthcare-aetna/ and https://www.beckerspayer.com/payer/medicare-advantage/medicare-advantage-plans-with-2-5-stars-or-lower-in-2027/ and https://www.kff.org/medicare/medicare-advantage-plan-availability-varies-widely-by-county-for-2027/ and https://www.kff.org/medicare/medicare-open-enrollment-and-coverage-options-key-questions-and-answers/ and https://www.kff.org/medicare/how-much-do-people-with-medicare-pay-for-coverage/
#medicareadvantage #stars #quality #cms #medicare
https://www.healthcaredive.com/news/medicare-advantage-stars-2027-winners-losers/832582/
Cybersecurity Threat From Quantum Computing
Healthcare organizations aren’t prepared for cybersecurity threats from quantum computing, which could compromise encryption in the near term. Medical devices lag behind traditional information technology systems in preparedness. Electronic medical records, medical imaging, and lab results are the data types most at risk.
#cybersecurity
Cuban’s Value Prop
A new analysis finds deep savings from Mark Cuban’s Cost Plus Drug vs. traditional pharmacy benefits managers. Cost Plus had prices for 71.5% of claims examined, representing 14.4% of the spending. Repricing the claims at Cost Plus’ rates would have cut the charges from $62.4 million to $20.8 million, a 67% reduction. Savings were concentrated in biosimilars of Humira and Stelara.
#drugpricing #branddrugmakers
Centene Expands ICHRAs
Centene is launching Custom Health Option and Individual Care Expense arrangements (CHOICE, formerly known as Individual Coverage Health Reimbursement Arrangements (ICHRAs), in four more states in 2027.
#employercoverage #ichras #choice
https://www.beckerspayer.com/payer/choice/centene-to-launch-choice-options-in-4-more-states/
— Marc S. Ryan
