SOTU Has Little On Healthcare
President Trump touted his accomplishments in his State of the Union address Tuesday but spent little time on affordability in healthcare. In the speech he did hit two main topics, but just for a total of five minutes of the marathon speech.
- The Great American Health Plan announcement – Trump doubled down on his desire to shift subsidy and support dollars from insurers to individuals to pick their own healthcare. In the speech and his original announcement, few details have been given about exact mechanisms for the proposal. It is more of an outline than a real plan. He shied away from mentioning the expired enhanced Exchange subsidies.
- Lower prescription drug prices – He also championed the work he has done on prescription drug prices. Here he has amassed a more comprehensive record, with a series of executive orders, most-favored-nation (MFN) model proposals for Medicaid and Medicare, and price negotiations with drug makers to lower prices.
I was not impressed with the vagueness of his health insurance coverage proposal but have given Trump a great deal of credit on moving the drug price needle. No one has been able to really do the latter before.
#trump #healthcare #coverage #drugpricing
https://www.healthcaredive.com/news/trump-state-of-the-union-healthcare-2026/812962
GoodRx Launches Employer Direct Program
GoodRx announced it will launch Employer Direct, a new program that will allow employers to offer workers lower costs on branded products. Through the program, firms can select branded drugs and subsidize the cost for the cash-pay price available through GoodRx.
The idea is that employers can lower employee costs by leveraging GoodRx existing discounts on pricey brand drugs and further lower ultimate cost through subsidies. It is hard to say exactly how much this will help compared with the existing pharmacy benefits manager (PBM) models and cost-sharing structure, but running such program parallel to existing models has promise.
#drugpricing #employercoverage #pbms
ACCESS Model Rates Low
Mixed reaction to the announcement of rates for the Trump administration proposed technology-based disease state monitoring program known as ACCESS for traditional Medicare. The program would send payments to tech firms who partner with providers to help improve outcomes and lower costs for those with chronic conditions. Four are initially targeted in the area of heart disease, diabetes, pain, and behavioral health.
Lower rates than expected could chill participation by firms and providers. Some note reimbursement may mean less overall revenue than regular Medicare billing for telemonitoring and related technology-based care.
At the same time, tech firms bring scale and efficiency to such monitoring. Volume of patients will be key in the program. Also, many providers have not gone down the monitoring road due to lack of expertise. Partnering with tech firms could derive new revenue streams. Too, part of the population cohort targets pre-diabetes and related conditions, which is an opportunity to influence behavior and prevent disease advancement.
#chroniccare #medicare #access
— Marc S. Ryan
