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
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
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
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
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
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/
#opioids
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
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
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
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
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
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
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
— Marc S. Ryan
