Politico Raises Issue Of CMS Premium Stabilization Demonstration For Medicare Part D PDPs
The mainstream media is finally covering the potential October Surprise for Democrats. There are possible huge increases in standalone Medicare Part D (PDP) premiums due to the transfer of costs to plans from the government and member out-of-pocket cost reductions in the Inflation Reduction Act (IRA). The Politico article lays it out well.
The Centers for Medicare and Medicaid Servies (CMS) created a last-minute demonstration to blunt the impacts and the GOP is accusing Democrats of using the U.S. Treasury for political purposes. I continue to doubt that CMS has the authority to do this. It usurps Congress’ control. I raised this issue in two blogs several weeks ago (July 24 and July 25) here: https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ and https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ .
In addition to the PDP premium hikes, Medicare Advantage (MA) plans are expected to have benefit cuts for a number of reasons, including the IRA changes and rate reductions.
Additional article: https://www.beckerspayer.com/payer/the-perfect-storm-facing-medicare-recipients-during-enrollment-season.html
#election2024 #medicareadvantage #partd #pdp #ira
https://www.politico.com/news/2024/08/13/biden-adiminstration-medicare-drug-premiums-spike-00173308
Trump’s HHS Secretary Says His Ex-Boss Could Out Flank Biden On Drug Price Reform
Former HHS Secretary Alex Azar says former President Donald Trump could go beyond Biden on drug price negotiations, building on things he did in his earlier term. Azar says Trump may not seek to dismantle Medicare drug pricing negotiations if re-elected and out-negotiate the Biden administration by seeking even lower prices. Trump also has said he may reignite international reference pricing and most-favored nation policies. The article covers other predictions for a Trump 47 administration.
(Article may require a subscription.)
#drugpricing #ira #branddrugmakers
First Medicare Drug Prices Expected Tomorrow
The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) will announce the prices for the first 10 drugs covered by the Medicare drug price negotiations passed as part of the Inflation Reduction Act (IRA). We will see how aggressive the administration has been.
Additional article: https://insidehealthpolicy.com/daily-news/stakeholders-gear-administration-tout-negotiated-drug-prices-thursday
(Some articles may require a subscription.)
#ira #drugpricing #branddrugmakers #cms
https://www.axios.com/2024/08/14/medicare-releases-first-negotiated-drug-prices
Nationwide Group Calls For 12-Month Medicaid Continuous Eligibility
A group of 188 federal and state organizations want Congress to pass 12-month continuous eligibility (CE) for adults enrolled in Medicaid and the state children’s insurance program (CHIP). As of now, the law requires CE for those under age 19. Some states extend it to all enrollees. The belief is that this will promote better outcomes and coverage stability.
#medicaid #coverage
Elevance Health Launches Primary Care Venture
Elevance Health will launch Mosaic Health, a primary care venture, with private equity firm Clayton, Dubilier & Rice. Elevance is behind in building associated provider practice groups compared with United and Humana.
#healthplans #primarycare #providers
Prominent Drug Coverage Stories In The News
A number of articles covering GLP-1s today. A study by actuaries found that GLP-1 coverage was cost effective when compared with no treatment at all, despite high prices. Another analysis finds that 3.4 million with employer-sponsored insurance used at least one of the first 10 drugs identified for Medicare price negotiations. Yet another analysis profiles the use of GLP-1s in the Exchanges.
Additional articles: https://www.kff.org/health-costs/press-release/while-medicare-drug-price-negotiations-dont-apply-to-private-insurance-3-4-million-people-with-employer-coverage-take-at-least-one-of-the-selected-drugs/ and https://www.healthsystemtracker.org/brief/how-many-people-with-employer-sponsored-insurance-use-the-drugs-slated-for-medicare-price-negotiations/ and https://www.healthsystemtracker.org/brief/insurer-strategies-to-control-costs-associated-with-weight-loss-drugs/#Utilization%20management%20tool%20usage%20among%20Marketplace%20plan%20formularies
(Some articles may require a subscription.)
#weightlossdrugs #drugpricing #employercoverage #exchanges #healthplans
— Marc S. Ryan
