Bipartisan Bills Seek PBM Divestitures From Health Plans
More evidence that some kind of pharmacy benefits manager (PBM) reform is coming on Capitol Hill: Democratic and Republican lawmakers now have bills to have health plans divest their PBMs. In the Senate, the bill is co-led by a very unlikely pair – liberal Sen. Elizabeth Warren, D-MA, and conservative Sen. Josh Hawley, R-MO. In the House, a companion bill is sponsored by Rep. Jake Auchincloss, D-MA. and Diana Harshbarger, R-TN. Hawley is among those anti-corporate welfare Republicans who are getting more active on healthcare issues.
The Patients Before Monopolies Act of 2024 would require insurers to sell off their PBMs within three years. The bill also would prohibit corporations that own PBMs or health plans from also owning pharmacies.
Other PBM reform proposals continue to gain bipartisan momentum. Some changes could come in the end-of-year stop-gap bill or sometime in 2025.
Additional articles: https://www.modernhealthcare.com/politics-policy/pbm-act-cvs-unitedhealth-cigna-elizabeth-warren-josh-hawley and https://www.healthcaredive.com/news/pbm-act-force-pharmacy-sales-introduced-unitedhealth-cigna-cvs/735233/ and https://thehill.com/policy/healthcare/5035450-bipartisan-lawmakers-want-to-force-health-insurers-pbms-to-sell-off-pharmacies/
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#pbms #healthplans #drugpricing
FTC Nominees Will Pare Back Anti-Trust Agenda
President-elect Donald Trump has named Andrew Ferguson to head the Federal Trade Commission (FTC) and Mark Meador for a GOP seat on the commission. Ferguson currently sits on the commission and will not need confirmation to become chairman. Meador will need Senate confirmation. Meador is a former anti-trust aide in the Senate, current law firm partner, current Heritage Foundation fellow, and co-author of Project 2025.
The nominations likely mean a paring back of the anti-trust agenda and a more pro-business agenda for the FTC. Ferguson wants to scale back or halt the commission’s healthcare privacy and artificial intelligence enforcement. Ferguson also said he would be more receptive to mergers than Khan and that he would repeal burdensome regulations. It is unknown whether the current PBM lawsuits will continue, which do have bipartisan support in Congress.
Additional article: https://insidehealthpolicy.com/daily-news/ferguson-poised-halt-ftc-s-privacy-ai-enforcement
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#pbms #ftc #antitrust #trump
Articles Examine Anti-Health Plan Vitriol Post Assassination
A few articles examining the anti-health plan vitriol that have surfaced on social media and in public post the assassination of UnitedHealthcare CEO Brian Thompson. My views can be found in this blog: https://www.healthcarelabyrinth.com/i-am-shocked-by-the-vitriol-post-unitedhealthcare-executives-assassination/
Additional article: https://thehill.com/policy/healthcare/5034574-elizabeth-warren-unitedhealthcare-ceo-shooting-response-warning/
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#tragedy #unitedhealthcare #healthplans #priorauthorization #claimsdenials
Ghost Network Lawsuit Against Elevance Health
An Elevance Health subsidiary, Anthem Blue Cross Blue Shield of New York, is facing allegations in lawsuits over so-called “ghost networks” – where out-of-network providers are included in provider directories as if they were in-network. Plaintiffs say the ghost network strategy is used to seek to comply on paper with state and federal network adequacy laws and to reduce care and costs to the health plan.
In general, scrutiny over networks are increasing throughout the nation and laws and regulations being passed to address the issue.
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#healthplans #networks #regulations
https://www.modernhealthcare.com/insurance/anthem-bcbs-ghost-network-class-action-lawsuits
Fitch Betters Outlook For Non-Profit Hospitals
Fitch Ratings has revised its credit outlook for the nonprofit hospital sector, moving from deteriorating to neutral in a 2025 outlook report. Fitch notes that hospitals have made “enough meaningful strides” to warrant the revision. The rating agency says hospitals have made steady improvement in operating margins and have controlled labor expense growth. They also have stronger cash flow positions. Fitch predicts margins will continue to improve, with operators reporting median operating figures between 1% and 2% in 2025.
One potential storm cloud: potential budget cuts under the Trump administration.
#hospitals #margins
https://www.healthcaredive.com/news/fitch-bumps-outlook-for-nonprofit-hospitals-2025/735141
GLP-1 Coverage Proposal In Medicare Under Attack
Budget hawk and conservative groups are urging the incoming Trump administration to scrap the Centers for Medicare and Medicaid Services (CMS) proposal to cover obesity drugs in Medicare. This could save $40 billion over roughly the next decade. Interestingly, Elon Musk has entered the fray as well arguing the better tack may be to bring down the drugs’ prices.
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#glp1s #weightlossdrugs #drugpricing #medicare #medicareadvantage #partd #pdp
Nursing Home Staffing Rule Destined For Scrapheap
The GOP administration or Congress is expected to repeal the Biden administration’s nursing home staffing rule. Advocates argue the rule will improve safety and quality, while the industry and opponents argue the rule is infeasible, will drive up costs, and lead to home closures and massive consolidation. A number of methods could be used to repeal the provisions, including using the Congressional Review Act or a regulation to rescind the rule.
#nursinghomes #staffing
https://thehill.com/policy/healthcare/5033563-nursing-home-staffing-rule-repeal-expected
— Marc S. Ryan
