January 19, 2024

Weight Loss Drugs Take Nation By Storm

Ozempic and other new drugs are all the rage for weight loss.  These new drugs have both great promise and the potential to be abused and drive up healthcare costs phenomenally.  See some of the trends here.

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#weightlossdrugs #healthcare

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Behavioral Health Pilot Announced By CMS

The Centers for Medicare and Medicaid Services announced a new behavioral health pilot for traditional Medicare and Medicaid. Physical and mental healthcare providers will form care teams with community organizations to coordinate care for the mentally ill and substance abusers.

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#behavioralhealth #medicare #medicaid

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House Budget Committee Passes Fiscal Commission Bill

Three Democrats and all Republicans came together to pass a fiscal commission bill in the House Budget Committee.  Such a commission would make recommendations on major fiscal issues, including Medicare. Congress would be required to vote on them. Of course, a commission makes good sense to help ensure programs’ future.  The bill likely will not pass in the Senate, where healthcare lead and Finance Chairman Sen. Ron Wyden, D-OR, opposes it.

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#fiscalcommission #medicare #socialsecurity #spending

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Medicare Doc Rate Fix Did Not Happen In CR

Medicare doctors are worried that a major Medicare rate cut has not been resolved yet.  It is ironic that the doctor lobby used a lot of their political muscle to gain prior authorization and similar reforms, but have yet failed to reverse the Medicare cuts. The lobby continues to push for a reversal, but is trying to determine whether a retroactive or prospective restoration makes the most sense.  A retroactive change could be complex and take time to implement.

Additional article here: https://insidehealthpolicy.com/daily-news/congress-passes-cr-without-doc-fix-despite-doctors-caucus-efforts

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#physicians #providers #rates #medicare

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PBM Reforms Still May Pass Congress

Despite the continuing government funding crisis, many are arguing that PBM reforms will continue to be a priority for passage.  Numerous bills were moved in both houses of Congress that would bring reporting and transparency, ban spread pricing, and mandate pass-through of rebates and other discounts to health plans.

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#pbms #drugpricing #healthplans

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Drug Price Increases Continue In January

Over 700 drugs have now seen price increases in January, including major new weight loss drugs which will now cost between $900 and $1,000 per month. Price hikes are about 4.5% on average, although some are much larger. Some drugs are dropping as they lose market share to generics. A majority of price hikes have traditionally occurred in January.


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Some Medicare Drug Price Negotiation Lawsuits Are On Procedural Grounds

Some of the nine filed lawsuits against the Inflation Reduction Act’s (IRA) Medicare price negotiations are on constitutional and statutory grounds, such as first amendment, takings, and due process violations. But at least three brand drug companies also are suing the federal government on procedural grounds. This Health Affairs Forefront blog goes into good details about various arguments the brand drug makers and other parties are making, including violations of the administrative procedures act.

While I continue to believe that the provisions will withstand statutory and constitutional scrutiny, it is possible that courts could find in drug makers’ favor on some procedural grounds. Courts have often ruled against agencies on rule-making grounds. This would not kill the law but simply delay it as the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) repromulgated rules and guidance.

A wild card here could be a potential Supreme Court ruling that could rein in agency regulatory power. (Article may require a subscription.)

#ira #drugpricing #medicare #medicareadvantage #partd

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Good Case Study On Ugly Hospital Lawsuits Against Those Unable To Pay

Kaiser State News’ article on an Oklahoma hospital that has sued so many in a small, financially struggling Oklahoma town is a case study in what is wrong with hospitals.  Now the hospital, too, is struggling, but its charity care is de minimis.  While some hospitals have stopped suits due to bad press and some states have taken action, many hospitals still sue throughout the U.S. despite getting large funding from government as well as charitable tax breaks.

#hospitals #surprisebilling

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— Marc S. Ryan

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