December 4, 2023

U.K. National Health Service Has New Drug Pricing Deal

An article in The Economist discusses the United Kingdom’s new drug pricing deal.  As we know, all other developed nations negotiate and set prices globally, as Great Britain does. The Inflation Reduction Act’s Medicare drug price negotiation will slowly bring some of what other developed nations have. In fact, we have some in force now.

Key points from the article:

  • The U.K. has among the lowest drug prices in the world because of its buying power.  Imagine the buying power of America?
  • The U.K. looks at the cost-effectiveness of new medicines to set prices.
  • It also has inflationary caps of 2% per year, which will increase to 4% in the new deal. Anything over this is returned in a rebate. Some drugs are exempt to encourage innovation.

Still, the U.K. says it is getting hurt by high-cost cancer and other drugs.

The U.K. and other systems work and should be fully in place in America.

(Article may require a subscription.)

#drugpricing #medicare #partd #uk #nhs

Link to Article

Good Argument For Debt and Entitlement Commission

The Heritage Foundation, a conservative think tank, has a great analysis of why a debt and entitlement commission is a good idea.  It is very factual.  A few points:

  • Congress cannot ignore the fact that Medicare spending is on a bad trajectory, despite recent analyses that show lower overall per-member expenditures over the last decade.  The fact is overall expenditures in government healthcare and healthcare as a whole will eat up more and more of budgets and the gross domestic product (GDP). Aging, technology, inflation, and more all contribute to this.
  • It also argues that Medicare Advantage is a great platform to create cost-effective reform.

#medicare #medicareadvantage #debt #deficit #healthcare #healthcarereform

Link to Article

Supreme Court To Review Sackler Family/Purdue Pharma Bankruptcy Agreement

The highest court will review the bankruptcy settlement decision related to the opioid crisis and the role Purdue Pharma and its founding family played in it.  One report says the justices may be divided. 

The review stems from a provision that protects the Sackler family from ever being civilly liable for other awards. Can or should a court really do this? My main beef with the settlement is that it allows the Sackler family to remain one of the richest in the nation even after handing over billions. 

The death and injury the company and some of the family members caused is incredible.  Purdue was found guilty once and the outrageous peddling of opioids continued to allow the family to make more and more money. Victims would receive between $3,500 and $48,000, with some spread over years. Atrocious.

Main article at the article link.  Another one is here: https://thehill.com/policy/healthcare/4341408-supreme-court-appears-divided-purdue-pharma-bankruptcy-deal/


Link to Article

Government Program Fraud Recoveries

The Health and Human Services’ Office of the Inspector General (HHS and OIG) is expected to recover almost $3.5 billion in FFY 2023 for Medicare, Medicaid, and other government healthcare programs. Don’t get me wrong, these recoveries are important.  But with the latest studies suggesting fraud, waste, and abuse is 25% of healthcare spending, actual improper payments in Medicare and Medicaid alone are in the hundreds of billions annually.

#fwa #hhs #oig #recoveries 

Link to Article

Big PBMs Implement Reforms To Forestall Legislative Action

Two of the country’s largest pharmacy benefit managers — Express Scripts (ESI) and Optum Rx — are proposing some reforms as to how they do business as major PBM oversight bills loom in Congress. 

ESI is introducing transparent pricing, while Optum Rx is proposing to make insulin more affordable on its formularies.

Numerous PBM oversight bills are being discussed and could bring major changes, including barring spread pricing, dictating a move to transparent pricing, major reporting requirements, and rebate pass-throughs at the point of sale. Employers and small start-up PBMs favor reforms, while larger, more-established PBMs do not.

(Article may require a subscription.)

#pbms #drugpricing

Link to Article

Ovarian Cancer Victim Raises Debt Retirement Funding For Others

Ovarian Cancer Victim Raises Debt Retirement Funding For Others

A beautiful story about a woman who has died of ovarian cancer and left an amazing legacy – raising money to help others retire their medical debt.  Thank you Casey McIntyre — RIP.


Link to Article

Important Recommendations To Address Medicaid Enrollment Decline

Great Health Affairs Forefront blog on the status of Medicaid redeterminations as eligibility rules come back post COVID.  Redeterminations of Medicaid eligibility began in April, and the authors do a good job of summing up what has happened.

  • Absolute Medicaid rolls are down over 7 million lives as of as of December 2023.
  • Medicaid enrollment of children has fallen by at least 2.8 million.
  • Setting aside new enrollment and reenrollment, states have disenrolled 11.8 million people since redeterminations began again.
  • 71 percent of those disenrolled were for “procedural” reasons.
  • We are only about 30% through all redeterminations. 
  • As many as 3.2 million children were expected to move to state children’s health programs or the Exchanges, that has not materialized.

I have reported that, based on various firms’ predictions, Medicaid enrollment losses would be about 15 million. As of now, things look like it could be so much worse.

The blog does a great job of laying out many things that states could do to lower the amount of procedural disenrollments, including breaking out child disenrollments, streamlining reenrollment among those disenrolled for procedural reasons, and improving transitions to separate CHIP or Marketplace coverage. They also comment on certain messaging and education that could be useful. 

The Centers for Medicare and Medicaid Services should read this thoroughly and demand action by states.

(Article may require subscription.)

#medicaid #redeterminations

Link to Article

Encouraging The PACE Program

Opinion piece in Modern Healthcare that encourages the expansion of the PACE program.  PACE dates back to 1970s and is a medical and long-term care program that integrates Medicare and Medicaid.

(Article may require subscription.)

#ltss #longtermcare #pace

Link to Article

Marc S. Ryan

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