January 2, 2024

KHN Series On Rural Healthcare Crisis

Good article from Kaiser Health News on the rural healthcare crisis.  It tackles how primary care doctors may be able to help with the maternal healthcare crisis. 

#ruralhealthcare #healthcare

Link to Article

More States Cover Illegal Immigrants’ Healthcare

This was surprising to me.  Eleven states and Washington, D.C.  provide full health insurance coverage to more than 1 million low-income immigrants regardless of their legal status.  Most are in California, but even Republican Utah is getting into the act. Coverage is expected to almost double by 2025.

In this other article, ABC News reports that CA becomes first state to offer full health benefits to all immigrants regardless of status: https://abcnews.go.com/Health/california-1st-state-offer-health-insurance-undocumented-immigrants/story?id=105986377

#immigrants #coverage #healthcare

Link to Article

Drug Price Hikes Coming

As happens each January, drug makers plan to raise prices in the United States on more than 500 drugs, according to data analyzed by healthcare research firm 3 Axis Advisors. At the same time, we are seeing some decreases coming from GSK on asthma inhalers as well as insulins more broadly.  But overall, the increases will occur and further hurt those needing medications. The Inflation Reduction Act’s (IRA) Medicare rebate provision will help some.

#drugpricing #brands #generics #branddrugmakers #ira

Link to Article

PBMs’ Margins 4.5% Or Less For First Three Quarters of 2023

STAT reports that the country’s four biggest pharmacy benefit managers reported a low margin in the first three quarters of 2023 of 4.5% or less.  This is well below drug makers’ margins. But it cautions that money can be moved around or hidden due to vertical integration in the healthcare industry.

(Article may require a subscription.)

#drugpricing #pbms

Link to Article

CA Bans Surprise Ground Ambulance Bills

Good for CA for banning ground ambulance surprise bills.  Many ambulance entities like to be out-of-network so they can charge exorbitant fees.  CA is fixing this by limiting cost-sharing to in-network rates. The issue is it probably means insurers will have to increase reimbursement dramatically, impacting premiums.  The national law exempts ground ambulance and continues to allow surprise billing.

#nsa #nosurprisesact #ca #surprisebilling

Link to Article

McKinsey Pays More For Opioid Settlements

Consulting company McKinsey will pay more for opioid settlements for its role in the crisis. Additional article here: https://thehill.com/regulation/court-battles/4382637-mckinsey-to-pay-78m-us-opioid-settlement-with-health-insurers-company-benefit-plans/


Link to Article

Molina Buys Bright Health’s MA Assets

Molina Healthcare will close on Bright Health’s Medicare Advantage (MA) assets sometime around January 1. This is at a lower price than originally agreed to.

#brighthealth #molina #medicareadvantage

Link to Article

New Healthcare Laws in States Effective In 2024

Good Modern Healthcare article on new healthcare laws in states.  Among the changes include a PBM reform law (including payment reform), various notification laws on mergers/acquisitions, malpractice law changes, additional state required benefits for primary care, requirements for providers to be able to access enrollment and cost-sharing information from insurers, notification of loss of network status to members by insurers, and caps on insulin costs.

(Article may require a subscription.)

#healthcare #healthinsurance #2024 #coverage #pbms #mergers #acquisitions

Link to Article

Mt. Sinai and United Healthcare Feuding

NYC-based Mt. Sinai and United Healthcare are in a dispute over rates in commercial products. Consequently, United will no longer have Mt. Sinai in its network right now.  Expect more disputes like this between insurers and providers as costs go up and more pressure on insurers develops to limit prior authorizations. Rates and network are the things insurers can work to lower costs as they look to other cost-containment strategies down the road.

#unitedhealthcare #managedcare #mtsinai

Link to Article

BSC Lays Off 165 Workers

Facing continued financial problems, Blue Shield of California lays off 165 employees.  It represents about 2% of the total workforce of approximately 7,500 employees.

(Article may require a subscription.)

#bsc #ca #layoffs #managedcare #healthcare

Link to Article

Biden Issues Presidential Determination To Help On Drug Shortages

Last week, President Biden issued a new presidential determination that gives the Department of Health and Human Services (HHS) more authority to boost manufacturing of essential medical products.  This is done through the Defense Production Act (DPA). HHS will use the authority to boost domestic production of starting materials for sterile injectable drugs.

(Article may require a subscription.)

#drugshortages #drugpricing

Link to Article

NY Wants To Ban Insulin Copays

NY Gov. Kathy Hochul, D, announced she wants to end all copays on insulin. But as the New York Health Plan Association notes, the money would have to come from somewhere.  While reasonable insulin cost-sharing and prices are important, a complete ban could increase premiums and shift costs to other areas.

(Article may require a subscription.)

#insulin #drugpricing

Link to Article

KFF Summarizes AHEAD Model From CMS

The Kaiser Family Foundation (KFF) published an analysis of the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The model seeks to reduce the rate of growth in health care spending, improve people’s health, and reduce disparities in health outcomes. CMS info here: AHEAD.

#kff #ahead #cms #healthequity

Link to Article

— Marc S. Ryan

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