Newsfeed

Medicare To Cover GLP-1s For Specific Conditions

Medicare Part D will cover obesity drugs if they are approved for specific medical conditions. For example, Novo Nordisk’s Wegovy, just received approval from the Food and Drug Administration (FDA) to reduce risk of stroke or heart attack in people with cardiovascular disease and who are obese/overweight. The same rule will apply to Medicaid. The decision does not make these weight-loss drugs available more broadly.

Additional article on trials showing GLP-1s slowing kidney disease progress and cardiovascular events: https://www.managedhealthcareexecutive.com/view/ozempic-reduces-kidney-disease-progression-cardiovascular-events-by-24-

Additional articles:

https://www.fiercehealthcare.com/payers/wsj-cms-broadens-part-d-coverage-obesity-drugs and https://www.medpagetoday.com/publichealthpolicy/medicare/109305

#weightlossdrugs #medicare #medicaid

Link to Article

Read More »

Both Class-Action And Provider Lawsuits Filed Against Change

Change healthcare will face both class-action lawsuits from patients as well as lawsuits from providers impacted by the Change Healthcare cyberattack. Meanwhile, provider groups, including the American Hospital association, are arguing the government and UnitedHealth Group responses have been inadequate and are pressing lawmakers to intervene with the Department of Health and Human Services (HHS).  The complaint is that advanced payments are simply not enough. Congress is also asking HHS if a bill needs to pass granting the agency flexibility in collecting advanced payments.

My blog tomorrow will be a comprehensive review of the Change cyberattack.

Additional articles: https://www.modernhealthcare.com/politics-policy/change-update-aha-financial-help-congress and https://insidehealthpolicy.com/daily-news/lawmakers-does-hhs-need-authority-allow-flexible-repayments-after-cyberattack

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

Link to Article

Read More »

Elevance Health To Buy Kroger Specialty Pharmacy

In an effort to further build out its Carelon service subsidiary, Elevance Health is buying Kroger Specialty Pharmacy.  This will add to its growing PBM offerings.

Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-acquire-kroger-specialty-pharmacy and https://www.modernhealthcare.com/finance/elevance-health-carelonrx-kroger-specialty-pharmacy

(Some articles may require a subscription.)

#kroger #elevancehealth

Link to Article

Read More »

Progress And Support During Change Healthcare Cyber Attack

Some services have been restored by Change Healthcare and more are readying.  Change says that claim preparation software for providers will soon come back online. Electronic payments have come back online. United says it has made more than $2 billion in advanced payments from its program.

United as an insurer, Highmark, and the Blue Cross and Blue Shield Association have developed advanced payment programs for providers, but many other insurers are moving slowly on the idea. Other insurers are contracting with Change competitors to help providers file claims. They also are extending claim deadlines. Provider groups say aid is not enough. The Centers for Medicare and Medicaid Services is also asking states to submit state plan amendments so they can advance Medicaid payments.

Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-update-unitedhealth-systems-progress and https://www.modernhealthcare.com/insurance/change-outage-prior-authorization-pay and https://www.modernhealthcare.com/government/change-update-cms-medicaid-reimbursements and https://www.healthcaredive.com/news/change-healthcare-cyberattack-medicaid-flexibilities-american-hospital-association-survey/710561/

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

Link to Article

Read More »

Medicare Households Spend The Most On Healthcare Costs

Good article from Fierce Healthcare and analysis from Kaiser Family Foundation on healthcare spending in Medicare households. Medicare households spend more on healthcare than other households. Health spending burden was twice as high.

Analysis by KFF: https://www.kff.org/medicare/issue-brief/medicare-households-spend-more-on-health-care-than-other-households/

#coverage #costs #medicare #medicareadvantage

Link to Article

Read More »

Change Pharmacy Network Back On

While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.

#clover #insurtechs

Link to Article

Read More »

Clover Health Readying For Positive Margin

While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.

#clover #insurtechs

Link to Article

Read More »

UnitedHealth Group CEO Hears From Becerra And Providers

At an unprecedented meeting, UnitedHealth Group CEO Andrew Witty heard from both Health and Human Services (HHS) Secretary Xavier Becerra and providers at a government sponsored meeting. The plea was for United to take responsibility for the Change Healthcare cyber attack and give        additional financial support to providers.

In addition, HHS detailed more about what a $1.3 billion fund for cyber security would be used for.  About 2,000 hospitals will receive incentive funds to adopt new cyber security practices. Another $153 million would go for various government initiatives.

Additional article: https://www.fiercehealthcare.com/providers/becerra-stakeholders-its-time-take-accountability-cybersecurity

#changehealthcare #unitedhealthcare #cyberattacks

Link to Article

Read More »

Biden Releases His FFY 2025 Budget

The President announced his FFY 2025 budget even as all bills for the current FFY 2024 year have not been approved (including Health and Human Services spending).  Biden did sign into law the bill that funds some agencies for the current fiscal year, including a partial retreat on a major Medicare doc cut. Because of the split in Congress, most of his proposals are dead on arrival but serve as campaign differentiators against his GOP opponent, former President Donald Trump.

In the FFY 2025 budget, Biden funds the commitments he made at the State of the Union and more:

  • Expanding the Inflation Reduction Act’s Medicare drug price negotiations
  • A $2,000 cap on commercial retail drug cost-sharing
  • A commercial insulin cap of $35 per month
  • A Medicaid-like program for those in the coverage gap
  • Almost $1.5 billion in cyber-attack funding
  • $150 billion over 10 years for home and community care expansions
  • Tax increases on the wealthy to help stabilize Medicare
  • Expansion of eligibility in Medicaid and the children’s health program
  • Elimination of children’s health premiums
  • A fix of funding caps in Medicaid for territories
  • Making the temporary enhanced premium subsidies in the Exchanges permanent
  • Major liberalization to ensure biosimilar uptake

Additional articles: https://www.modernhealthcare.com/politics-policy/biden-budget-cybersecurity-insurance-subsidies and https://insidehealthpolicy.com/health-insider/admin-releases-budget-addresses-fallout-over-change-healthcare-attack and https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more

(Some articles require a subscription.)

#budget2025 #healthcare #healthcarereform

Link to Article

Read More »

Biden SOTU Address Fiery And With Major Expansion Requests

President Joe Biden gave a fiery campaign speech at the State of the Union Thursday.  He touched on policy changes he wants to see across government and society.  In the healthcare world, he asked for significant additions to what he thinks is his successful record:

  • Major expansion of Medicare drug price negotiations.  As opposed to the maximum of 60 drugs in the current law, Biden wants the ability to negotiate the prices of 500 drugs over the next decade.
  • Permanent expansion of enhanced premium subsidies in the Exchanges.
  • A special healthcare program for those in the coverage gap in the ten states that have not expanded Medicaid.
  • A $2,000 annual cap on drug cost-sharing in commercial products.
  • A $35 per month insulin cap in commercial products.
  • Extension of inflation-cap drug rebates to commercial products. 

Additional articles: https://www.fiercehealthcare.com/payers/biden-call-drug-negotiation-expansions-stronger-reproductive-care-access-sotu and https://insidehealthpolicy.com/daily-news/biden-advocates-expansion-drug-price-controls-aca-state-union and https://www.modernhealthcare.com/politics-policy/joe-biden-state-union-sotu-2024

(Some articles may require a subscription.)

#biden #sotu #healthcare #healthcarereform #aca #obamacare #exchanges #drugpricing #ira #coveragegap #insulin

Link to Article

Read More »

Available Now

$30.00