February 22, 2024

New Poll Suggests MA Enrollees Have Issues With Prior Authorization, But Some Use Added Benefits

A new poll says Medicare Advantage (MA) enrollees are more likely than those in traditional Medicare fee-for-service (FFS) to experience care delays due to prior authorization, but they do receive supplemental benefits not in the traditional program. While the rates of such use can always be better, a 70% member-use rate is encouraging.  Still, it is indeed time for MA plans to show their value by encouraging the use of all of the added benefits at reasonable rates. Proposed supplemental benefits reporting rules will encourage this trend. Overall, MA plans need to educate members thoroughly on all benefits, lest critics and researchers build a case that there is no added value. The critics continue to argue massive overpayments, which I do not agree with.

One point just does not resonate with me. About 12% of MA members said they had affordability issues while about 7% of traditional Medicare enrollees said so. With all that MA does to reduce gaps in traditional benefits, it makes little sense to me.

Additional article:  https://www.medpagetoday.com/special-reports/features/108846

#medicare #medicareadvantage

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Bipartisan Group Of State Attorneys General Want PBM Reform

The National Association of Attorneys General sent a letter to House and Senate leaders imploring them to address drug costs by passing PBM reform legislation. The letter was signed on a bipartisan basis by 38 states.

(Article may require a subscription.)

#pbms #drugpricing

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More Trouble On Primary Care Front For Walgreens

In what is a very lucrative primary care market for seniors, Walgreens will close all of its VillageMD clinics in Florida to cut costs. This continues the troubles of the ailing retail drug chain.

Additional article here: https://www.modernhealthcare.com/providers/walgreens-villagemd-florida-clinics-closed-exit-market

(Some articles may require a subscription.)

#walgreens #primarycare

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Drug Study Shows Marked Reduction In Medicare Drug Prices Projected

A great Center for American Progress analysis says that 30-day net price reductions for the ten negotiation-eligible drugs could range from $30 to $6,548. The net price reduction estimates appear to be about a 50% reduction in net prices.

#ira #drugpricing #branddrugmakers

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House Freedom Caucus Wants Year-Long Stopgap Funding Measure

Oh how the tides turn.  The rightist House Freedom Caucus has long argued that passing spending bills and meeting deadlines are key.  Now, fearing that Speaker Mike Johnson, R-LA and one of their own, cannot get controversial policy riders and reductions in a negotiated package, the rabble rousers are asking for a year-long stopgap funding bill as that would trigger automatic cuts.

#governmentshutdown #speakerjohnson

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Kaiser Chart Collection On ACA Support

In a recent newsfeed, we discussed a new Kaiser Family Foundation poll that shows widespread support for the Affordable Care Act (ACA).  The charts clearly show this.

#aca #obamacare #exchanges #medicaid

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— Marc S. Ryan

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