Biden Releases Next 15 Medicare Drugs To Be Negotiated
In a parting shot at the incoming Trump administration, outgoing President Biden’s administration issued the next list of 15 drugs subject to negotiations in Medicare. The list was due by February 1, so the early release is a challenge to the Trump administration not to repeal the negotiation law included in the Inflation Reduction Act (IRA). The prices on the 15 drugs would go into effect on January 1, 2027 after a process in 2025. In 2024, prices for the first 10 drugs were set and take effect on January 1, 2026.
The Centers for Medicare and Medicaid Servies (CMS) says that between November 2023 and October 2024 about 5.3 million people with Medicare Part D coverage used these drugs to treat a variety of conditions, such as cancer, type 2 diabetes, and asthma. The drugs accounted for about $41 billion in total gross covered prescription drug costs under Medicare Part D, or about 14%. If you combine these drugs with the 10 drugs with prices set in the first round, over a third of total gross covered prescription drug costs under Medicare Part D will already have been subject to negotiation. Part B medical drugs will be added to the program for price negotiations for 2028.
In a related note, the administration also proposed to make GLP-1 drugs available for weight loss in Medicare if beneficiaries have only obesity and no other disease state usually found when treating conditions with such drugs. Trump will have to decide whether he keeps the provision, which is extremely costly and could further destabilize the standalone Part D program (but also hurt Medicare Advantage).
The drugs for round 2 are:
- Ozempic; Rybelsus; Wegovy
- Trelegy Ellipta
- Xtandi
- Pomalyst
- Ibrance
- Ofev
- Linzess
- Calquence
- Austedo; Austedo XR
- Breo Ellipta
- Tradjenta
- Xifaxan
- Vraylar
- Janumet; Janumet XR
- Otezla
CMS Fact Sheet: https://www.cms.gov/newsroom/press-releases/hhs-announces-15-additional-drugs-selected-medicare-drug-price-negotiations-continued-effort-lower
Additional articles: https://www.modernhealthcare.com/politics-policy/ozempic-wegovy-medicare-price-negotiations and https://www.healthcaredive.com/news/medicare-drug-price-negotiations-second-round-semaglutide/737662/ and https://insidehealthpolicy.com/daily-news/biden-s-hhs-bids-farewell-list-15-drugs-including-glp-1s-next-negotiations and https://thehill.com/policy/healthcare/5091213-medicare-negotiation-drugs-list/ and https://thehill.com/policy/healthcare/5091255-cms-negotiation-ozempic-list/ and https://thehill.com/homenews/5090719-biden-administration-picks-15-more-drugs-for-medicare-negotiation/
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#ira #drugpricing #medicare #partd #branddrugmakers #biden #trump
https://www.fiercehealthcare.com/payers/biden-names-cancer-diabetes-drugs-price-negotiation-program
House Ways And Means Outlines $3 Trillion In Cuts
Republicans are moving fast to assemble cuts to pay for the 2017 Trump tax cut extensions. The House Ways and Means committee has assembled a 50-page list of $3 trillion in cuts from various public and private organizations, including its own Republican Study Committee. The House Budget and Energy and Commerce committees also have lists. The three committees hold cognizance over health matters in the lower chamber. Any cuts could be rolled up into one or two budget reconciliation bills this year.
The cuts include:
- Eliminating nonprofit status for hospitals
- Banning hospital facility and telehealth fees
- Site-neutral payments in Medicare
- Cutting graduate medical education and uncompensated care
- Nursing home staffing mandate repeal
- Tightening access to Exchange subsidies
- Eliminating the Medicaid expansion enhanced funding
- Major Medicaid reductions, including a possible per capita cap program, work requirements, and provider tax funding schemes. The per capita cap program limits growth in Medicaid but is seen as not as hurtful as a global block grant to each state.
See my complete list of possible cuts in this blog: https://www.healthcarelabyrinth.com/what-could-healthcare-spending-cuts-look-like/ .
You may see some radical restructuring proposals on the list, but I have said that I doubt radical restructuring will occur for a number of reasons, including tight vote counts in each house of Congress. We shall see.
Additional articles: https://insidehealthpolicy.com/daily-news/medicare-physician-pay-site-neutral-broad-hospital-pay-reforms-wm-reconciliation-wish and https://insidehealthpolicy.com/daily-news/gop-find-billions-savings-medicaid-provider-tax-reforms-repealing-eligibility-rules and https://insidehealthpolicy.com/daily-news/family-glitch-rule-chopping-block-budget-options-menu-floated-friday and https://insidehealthpolicy.com/daily-news/ira-drug-price-reforms-reconciliation-wish-list-phrma-pushes-pill-penalty-fix and https://thehill.com/business/5092129-house-budget-republicans-eye-more-than-200-spending-cuts-tax-changes-for-major-bill/?tbref=hp
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#trump #congress #taxcuts #healthcare #spending #budgetreconciliation
https://www.modernhealthcare.com/politics-policy/medicaid-cuts-gop-block-grants
Almost Two-Thirds Of Americans Have A Favorable View Of ACA
The latest Kaiser Family Foundation (KFF) tracking poll finds that 64% of Americans have a favorable view of the Affordable Car Act (ACA). About 82% view Medicare and 77% view Medicaid favorably. About 51% say government does not spend enough on either Medicare or Medicaid. More than half (55%) of the public say it is a top priority to expand the number of prescription drugs subject to Medicare drug price negotiations.
Additional articles: https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable–Unfavorable&aRange=twoYear and https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-public-weighs-health-care-spending-and-other-priorities-for-incoming-administration/ and https://www.kff.org/health-costs/press-release/as-congress-looks-to-reduce-federal-spending-medicare-and-medicaid-remain-broadly-popular-and-at-least-twice-as-many-people-want-to-increase-spending-rather-than-cut-it/
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#healthcare #medicare #medicaid #aca #obamacare #exchanges
Over 24 Million Selected Exchange Coverage For 2025
The Biden administration announced near-final numbers for enrollment in the Exchanges for 2025. About 24.2 million ended up enrolling by the January 15 deadline. There were about 3.9 million new enrollees as well.
#aca #obamacare #exchanges #coverage
MultiPlan And Payers Push To Dismiss Antitrust Lawsuits
MultiPlan and its partner health insurers are asking courts to dismiss provider lawsuits on antitrust allegations. The vendor and payers are accused of price-fixing, limiting out-of-network reimbursement, and pushing huge costs on to consumers.
Additional article: https://www.modernhealthcare.com/legal/multiplan-aetna-blue-shield-ca-antitrust-lawsuit-dismissal
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#surprisebilling #nsa #healthplans #multiplan #providers #payments
MedPAC Votes On 2026 Hospital Rate Hike
The Medicare Payment Advisory Commission (MedPAC) recommended that Congress bump Medicare pay rates for hospitals in 2026. It voted for an increase in general acute care hospitals’ base payment rates for inpatient and outpatient services by the amount specified in current law plus an additional 1%.
#hospitals #medicare #rates
https://www.fiercehealthcare.com/providers/medpac-votes-recommend-hospital-pay-increases-2026
False Claims Act Recouped Almost $3 Billion In 2024
The Department of Justice (DOJ) announced it recouped more than $2.9 billion for the federal government from False Claims Act settlements and judgements during the 2024 fiscal year, with nearly $1.7 billion of the total related to healthcare.
In other news:
- Pro Publica had a lengthy article on the impact of insurance claims denials on mental health treatment. There are major concerns that continued treatment is not approved. In the tracking poll noted above, the American public also said insurance denials are a major concern and top priority for reform.
- Antitrust regulators reached a deal with Welsh, Carson, Anderson, and Stowe that tries to prevent the private equity firm from future healthcare rollups. The firm was accused of controlling too much of the anesthesia market. I find that the deal is a bad one for America. At the same time, the regulators were in a tough situation.
- The DOJ is suing Walgreens for its role in the opioid crisis.
Additional articles: https://www.healthcaredive.com/news/false-claims-settlements-healthcare-2024/737551/ and https://www.modernhealthcare.com/insurance/mental-health-insurance-claim-denials-unitedhealth-cigna-blue-cross-blue-shield and https://www.healthcaredive.com/news/ftc-welsh-carson-settlement-anesthesia-texas-usap/737714/ and https://www.beckershospitalreview.com/legal-regulatory-issues/justice-department-sues-walgreens-over-alleged-part-in-opioid-crisis.html
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#doj #fwa #healthcare #mentalhealth #priorauthorizaion #claimsdenials #ftc #opioids #walgreens
— Marc S. Ryan