PBMs Took Payments From Drug Makers During Opioid Crisis
A New York Times multi-part expose continues its attacks on the pharmacy benefits manager (PBM) industry. In its latest investigation, the newspaper tells us that PBMs took payments from opioid manufacturers in return for not restricting the flow of pills. PBMs collected billions while tens of thousands overdosed and died from the prescription painkillers. Among the drug manufacturer payors was Purdue Pharma and the disgraced Sackler Family.
Slowly but surely the roles of various drug channel stakeholders have come to light, from drug makers to wholesalers to PBMs to pharmacies. It is a national tragedy stoked by greed. All of the corruption needs to come to light and violators civilly and criminally held to account.
The report is sure to turn up the heat even more on PBMs on Capitol Hill.
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#nyt #opioids #branddrugmakers #pbms
https://www.nytimes.com/2024/12/17/business/pharmacy-benefit-managers-opioids.html
CMS To End VBID Due To Costs
The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model at the end of 2025. CMS concluded it was too costly because of “increased risk score growth and Part D expenditures” among participating plans. It says Medicare spent $4.5 billion on VBID in CY 2021 and 2022 combined.
On one hand, the offerings under VBID are now readily available under other supplemental benefit expansions. But some recipients could be impacted, especially on the Part D side.
Overall, this could be a sign that CMS now sees far too many demonstrations in Medicare that have little return. Reining them in and simplifying them for providers are key.
#vbid #medicareadvantage #medicare #partd
What Will Medicare Advantage See In 2025
The enrollment season is closed and many expect growth in Medicare Advantage (MA) despite major headwinds felt by insurers. Health plans are already battling new costs from regulations as well as utilization and inflation trends. More changes have been unveiled for 2026 and beyond. Some of these changes may not be adopted by incoming President Trump. Trump will be friendlier to MA, but expect scrutiny just the same.
#medicareadvantage #healthplans #trump #oz
https://www.fiercehealthcare.com/payers/2025-outlook-whats-next-medicare-advantage
Killer Charged With First Degree Murder
Luigi Mangione was formally indicted in New York on first-degree murder charges for the fatal shooting of UnitedHealthcare CEO Brian Thompson.
In very troubling news, a new survey found that of those aged 18-29, 24 percent found the killing was “somewhat acceptable,” and 17 percent found it completely acceptable. What is the world coming to?
Additional articles: https://www.modernhealthcare.com/people/luigi-mangione-indicted-first-degree-murder-brian-thompson-unitedhealthcare-ceo and https://thehill.com/policy/healthcare/5044269-poll-finds-41-percent-find-killing-unacceptable/
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#tragedy #unitedhealthcare
https://thehill.com/regulation/court-battles/5044994-united-healthcare-ceo-suspect-indicted
Congress Reaches Agreement On Stop Gap
It appears Congress has reached a deal in principle on funding government through March 14, which will include key healthcare changes that extend various programs and includes a 2.5% increase in Medicare physician pay. Pharmacy benefit manager (PBM) reforms across lines of business is included.
Speaker Mike Johnson will have to rely on Democratic votes as a number of House rightists will not support the bill. Also, Sen. Rand Paul, R-KY, is threatening to hold up the continuing resolution (CR) unless leaders in Congress agree to vote on amendments to offset the cost of new spending in the proposal.
Additional articles: https://thehill.com/policy/healthcare/5045169-health-care-package-pbms-funding-bill/ and https://thehill.com/homenews/senate/5044487-rand-paul-threatens-government-delay/
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#governmentshutdown #crs #healthcare #congress
Another Brand Drug Maker Sues Over 340B Drug Program
Brand drug maker Sanofi has joined other pharmaceutical manufacturers in suing the federal government over its moves to block the companies’ proposed changes to how they issue 340B drug discounts.
Additional article: https://www.healthcaredive.com/news/sanofi-sues-hhs-340b-rebate-policy/735736/
(Some articles may require a subscription.)
#drugpricing #340b #hospitals #branddrugmakers
https://www.modernhealthcare.com/legal/sanofi-hhs-lawsuit-340b-drug-pricing-rebate-model
Biden Extends ACA Exchange Enrollment Deadline
Faced with enrollment numbers lagging last year, President Biden extended federal Exchange enrollment from Dec. 15 to Dec. 18 for January 1 enrollment. February 1 enrollment goes to Jan. 15.
#aca #exchanges #biden
https://www.axios.com/2024/12/17/bidens-affordable-care-act-enrollment
— Marc S. Ryan
