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Cuban Recommends Radical Change In Drug World To Reduce Costs

I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system.  So when he speaks, I listen.  At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency.  He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.  

The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system.

But Cuban’s transparency and frankness is where the drug world needs to go. Cuban and advocates for reform also noted that at least some of the shortages we are seeing now are caused by the traditional opaque pricing and delivery channels. Cost Plus Drugs will begin manufacturing generics, targeting some with major supply issues. Hopefully Cuban’s radical approach gets people to think differently. PBMs need to reform. Brand drug makers have to embrace lower prices while safeguarding innovation. Direct-to-consumer models are the way to go.

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/biden-admin-urged-cut-ties-top-pbms-achieve-lower-drug-costs

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#drugpricing #cuban #costplusdrugs #pbms #healthcarereform

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FFY 2024 Spending Package Agreed To By Key Lawmakers

A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates.

Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/

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#governmentshutdown #healthcare

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Medicare Advantage Will Remain Viable Over The Long Run

Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.”

This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ).

As I say, the real victims of terrible policies from the Centers for Medicare and Medicaid Services (CMS), such as the prior authorization rule, will be fixed income seniors who will lose a great deal of benefits.  It is a shame.

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#medicareadvantage

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