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Could Trump Bring Back International Reference Pricing

Interesting Forbes article alluding to a December dinner with President-elect Trump attended by Eli Lilly CEO David Ricks. Apparently, international reference pricing to set Medicare drug prices was discussed. Subsequently, Ricks has alluded to the need to increase prices abroad in developed countries, leading some to speculate Trump could re-issue his proposal for adopting the most favored nation prices for Part B medical drugs in Medicare. At the time, Trump said he might even make the proposal applicable to Part D retail drugs in Medicare.

During the campaign, he seemed to swear off the idea, but we know Trump changes his mind. He is also obsessed by being ripped off by other nations. Drug pricing is a great example. Drug makers agree to low prices in other developed countries because America pays for the vast majority of its profits (about three-quarters). The money earned in other countries is gravy.

#drugpricing #branddrugmakers #trump #medicare #partd #partb

https://www.forbes.com/sites/joshuacohen/2025/01/03/trump-may-revisit-most-favored-nation-model-for-prescription-drug-prices

Murkowski Supports Exchange Premium Subsidy Extensions

Sen. Lisa Murkowski, R-AK, says she supports extending enhanced premium subsidies in the Exchanges because of the help it has provided people to afford coverage. Betting odds are still that the GOP-controlled Congress will allow the subsidies to expire at the end of 2025. But Murkowski’s statement leaves some hope for a long-shot, one-year extension some time in 2025.

#exchanges #aca #obamacare

https://thehill.com/policy/healthcare/5066188-murkowski-obamacare-premium-subsidies

Laws And Rules That Went Into Effect as of January 1

A series of new healthcare federal and state laws and regulations went into effect on January 1.

A federal rule update requires new fields and data related to pricing that must be disclosed by hospitals related to the price transparency requirements. This will create greater compliance, consistency, and better comparisons of prices.

States enacted laws that restrict prior authorization, expand mandated benefits, expand Medicaid, require bias training, require cybersecurity audits, reform pharmacy benefit managers (PBMs), restrict cost-sharing for drugs, and undertake medical-debt reform.

Additional: article: https://www.modernhealthcare.com/government/state-healthcare-laws-2025-california-illinois-minnesota-arkansas

(Some articles may require a subscription.)

#2025 #healthcarereform #regulations

https://www.statnews.com/2025/01/02/hospital-price-transparency-rules-2025-cms/

Hospitals In Better Financial Shape Going Into 2025

Hospitals and health systems are on better financial footing than a year ago. Operating margins, cash flows, outpatient revenue, average inpatient length of stay, and outpatient revenue improved from 2023. For many providers (in particular health systems), volumes have rebounded to above pre-pandemic levels.

In October 2024, the mean operating margin for hospitals was 4.4%, up from 2.5% in November 2023 and 2.7% in December 2023, says consulting firm Kaufman Hall.

Labor expenses have dropped and inflationary pressures have subsided. But there has been continued growth in supplies, drug expenses, and purchased service expenses.

On the policy front, hospital groups are worried about budget cuts under the incoming Trump administration that could lead to the expiration of Exchange enhanced subsidies, rate cuts in Medicare and Medicaid, and a pullback on coverage overall. As well, smaller entities could struggle on the cybersecurity preparedness front.

#hospitals #providers #cybersecurity #coverage #medicare #medicaid #costs #rates #drugpricing #exchanges

https://www.fiercehealthcare.com/hospitals/2025-outlook-hospital-finance-show-signs-stability-rising-costs-will-be-headwind

Kennedy And Oz At Odds On GLP-1s

Department of Health and Human Services (HHS) Secretary-nominee Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator-nominee Dr. Mehmet Oz are at odds over support for GLP-1 weight-loss drugs.

Oz has opined that the drugs could have a positive effect on weight loss and reducing disease prevalence. Kennedy sees them as a scam and insists that the American public simply needs to eat better.

The Biden administration has proposed in a draft rule to provide Medicare Part D coverage for obesity alone. Trump will need to finalize the rule or remove the provision. This will be the first test of who will win the GLP-1 coverage war.

The drugs are expensive at $1,000 or greater per month at list price.

#glp1s #weightlossdrugs #drugpricing #branddrugmakers

https://thehill.com/policy/healthcare/5055607-rfk-jr-vs-oz-sets-up-clash-on-weight-loss-drug-coverage