CMS Cuts Off Broker Access To SSNs
Kudos for Kaiser Health News’ articles and focus on fraudulent switching in the Exchanges by untrustworthy agents. The trend has caused a lot of misery for enrollees. One problem was the access by agents and brokers to full social security numbers (SSNs). As of today, that has been cut off by the Centers for Medicare and Medicaid Services (CMS) in the federal Marketplace. Henry Kaiser is smiling from heaven.
#kff #khn #fwa #exchanges #aca
Advocates And Insurers Urge Extension Of ACA Premium Enhancements For One Year
Advocates and insurers are right that Congress should extend the enhanced premium subsidies for the Exchanges sometime in 2024. They are set to expire Dec. 31, 2025, but should be extended to the end of 2026. Why? Because plans submit proposed benefits and rates in early 2025 for 2026. If the premium enhancements are not extended, that would force plans to make assumptions about major reductions in enrollment and changes in selection. As well, premiums would increase dramatically without the premium enhancements for the vast majority of enrollees.
The extension would give a new Congress time to decide what to do – extend, pare back, or let the enhancements lapse. The reality is that any extension is unlikely in 2024 given Republican control of the House – as tight as that is.
(Article may require a subscription.)
#aca #obamacare #exchanges #premiums
Advocates Urging Use Of Different March-In Concept To Lower Price Of Xtandi
Advocates are urging the federal government to use a related “march-in right” provision not related to price abuse to lower the price of prostrate drug Xtandi.
(Article may require a subscription.)
#drugpricing
VA Governor Vetoes Drug Price Control Board
Virginia Governor Glenn Youngkin, a Republican, vetoed a bill that established a prescription drug affordability board as seen in other states. Youngkin rejected it as a price control measure. The bill would have established upper limits on drug costs. There is no hope of an override.
(Article may require a subscription.)
#drugpricing #va
Big PBMs Protected Brand Drugmakers Over Biosimilars
A new study says the Big 3 pharmacy benefits managers (PBMs) created an environment where up to $6 billion in savings were lost for health plans and consumers on biosimilars for Humira because of shadowy rebate and other fee schemes between the brand drug maker and the PBMs. I have no reason to doubt this. We see the favoring of brand drugs through rebates on formularies over cheaper generics. This leads to more profits for PBMs – the study said $2 billion. It happens all the time and is a case study why transparency and cracking the rebate system is essential.
(Article may require a subscription.)
#drugpricing #rebates #branddrugmakers #pbms
House Committee To Hold Hearing On Overpayments
With a recent Government Accountability Office (GAO) report saying Medicare and Medicaid combined had over $100 billion in overpayments in 2023, the House Energy and Commerce Committee (a healthcare committee of cognizance with Ways and Means) will hold a hearing.
(Article may require a subscription.)
#fwa #medicare #medicaid
NYT Article Says Medical Debt Not Showing Rewards
Interesting article on a study that says non-profits buying medical debt for pennies on the dollar are not really freeing families from financial distress. On its face, I just don’t quite understand the conclusions. It needs more review – as the study itself concludes.
(Article may require a subscription.)
#medicaldebt #healthcare
The Coming Months Of Medicare Drug Price Negotiations
Excellent Health Affairs Forefront blog on what is in store in 2024 for Medicare drug price negotiations. The others review how the Centers for Medicare and Medicaid Services (CMS) set the maximum fair price and the initial offer.
(Article may require a subscription.)
#drugpricing #brandrugmakers #cms
Supreme Court Could Reverse Chevron Deference; Major Impact On Healthcare
Two major cases in the Supreme Court could reverse so-called Chevron deference. The current paradigm gives regulatory agencies significant flexibility in interpreting and handing down rules. A court decision to rein it in could have far-reaching impacts on rule-making across all agencies, including healthcare ones.
#healthcare #regulations
The Interesting Timing Of The House Republican Study Committee Healthcare Proposals
Drew Altman of Kaiser does a good job putting the House Republican Study Committee’s unique timing of offering healthcare reform proposals. They did it right in the thick of the presidential election, with Donald Trump offering few healthcare policies.
I agree with some but not many of the proposals. At the same time, I applaud any reform proposals during an election year. Most lawmakers and politicians refuse to engage on an important issue. It is almost as if our healthcare programs are not on the verge of insolvency.
#medicare #medicaid #aca #obamacare #healthcare #healthcarereform
— Marc S. Ryan
