State AGs Want Healthcare Entities With PBMs Broken Up
A bipartisan group of state attorneys general wants Congress to pass legislation that would break up healthcare entities that own both pharmacy benefits managers (PBMs) and pharmacies. This targets UnitedHealth Group, CVS Health, and The Cigna Group, which control somewhere between 68% and 80% of the PBM market. At issue, too, is co-manufacturing of specialty medications.
More and more state regulation of PBMs is passing. There is a growing bipartisan consensus in Congress for the need to reform PBMs.
Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/state-ags-demand-congress-ban-pbms-owning-pharmacies
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#pbms #drugpricing
https://www.modernhealthcare.com/politics-policy/cvs-caremark-express-scripts-arkansas-vermont
Fitch Says MA Rate Hike Will Help Stabilize Recovery
Fitch, a rating agency, says the increased Medicare Advantage (MA) 2026 rate hike of over 5% “will likely significantly support the recovery” of MA plans as they face rising medical costs. But the rater notes that they do not resolve all the challenges facing MA insurers, but relieve some pressures.
#medicareadvantage #rates
J&J Expects Big Hit On Medtech
Johnson & Johnson is predicting tariffs will cost it $400 million this year, largely impacting its medtech devices business.
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#tariffs #healthcare
PEPFAR To Be Cut 40%
The White House will likely cut the United States President’s Emergency Plan for AIDS Relief (PEPFAR) program by some 40%. The Trump administration says that the program will remain important, but advocates argue it will gut one of the most successful prevention efforts in the world. The program was begun by Republican George W. Bush.
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#hivaids #healthcare #grants #doge #budgetreconciliation
https://insidehealthpolicy.com/daily-news/white-house-will-ask-congress-cut-pepfar-about-40
Dems Want Biden Proposal To Expand GLP-1s In Medicare And Medicaid
A group of Democratic senators are calling on Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. to keep a Biden proposal to expand GLP-1 coverage in Medicare and Medicaid for those who are obese (but may not have other underlying disease states).
I think the Trump administration was being fiscally prudent in rejecting the expansion in the finalization of a recent rule. Check out by blog on this from Monday: https://www.healthcarelabyrinth.com/fetterman-is-right-on-glp-1s-but-now-is-not-the-time-to-expand-coverage-in-medicare/ .
#glp1s #weightlossdrugs #healthcare
https://thehill.com/policy/healthcare/5250440-democrats-rfk-jr-medicare-medicaid-obesity-drugs
ACO Program Gaming
This Health Affairs Forefront Blog is a good review of how Accountable Care Organizations (ACOs) can game the system to show “savings” and gain incentives. The gaming includes geographic considerations, upcoding, beneficial selection, and choosing the right physicians. Even then, pilots seem to amount to losses overall for the fee-for-service Medicare system.
#medicare #acos
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Work Requirements Mean Unintended Eligibility Losses
Another study concludes that work requirements in Medicaid could mean major losses in coverage even though recipients meet requirements. The Urban Institute concludes that hundreds of thousands to millions of people across all four U.S. regions who are working, participating in work-related activities, or meeting exemptions could potentially lose Medicaid coverage in 2026.
We have some evidence from Arkansas and Georgia that seems to back up the losses as well as administrative expense of work requirements.
#workrequirements #medicaid #budgetreconciliation
KFF Briefer On Brainwood
The Supreme Court will hear oral arguments in Kennedy v. Braidwood Management soon. The case challenges the legality of the Affordable Care Act’s (ACA) requirement to cover preventive services free of charge. Health policy group KFF has issued a good briefer explaining what is in debate.
#prevention #preventiveservices #aca #obamacare
— Marc S. Ryan
