January 4, 2024

Hospitals, Payers Have Better Compliance With Transparency Requirements

Hospitals and payers seem to be complying more with required price transparency postings.  As well, the Centers for Medicare and Medicaid Services (CMS) has ramped up enforcement.  New rules went into effect 1/1 and Congress wants to codify the rules and enhance them. Additional article here: https://www.medpagetoday.com/special-reports/features/108126

#transparency #pricetransparency #healthplans #hospitals #cms

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Physician and Hospital Groups Object To Info-Blocking Penalties In Proposed Interoperability Rule

Provider and hospital groups dislike proposed penalties for info-blocking under a new proposed interoperability rule.  Penalties include a change in meaningful-use status in federal programs and reductions in payments.

Additional article here: https://insidehealthpolicy.com/daily-news/stakeholders-seek-less-severe-penalties-potential-info-blocking-claims

(Some articles may require a subscription.)

#interoperability #infoblocking #hospitals #providers

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Lawmakers Miss Medicare Advantage’s Benefits

Lawmakers at a symposium on Medicare drug pricing complained that healthcare inflation is impacting Medicare provider payments and hurting access for Medicare beneficiaries. They also complain of provider confusion with all the parts of Medicare.  The answer is invest in Medicare Advantage (MA).  Instead, lawmakers on both sides seem to be endorsing ridiculous prior authorization limitations along side the Centers for Medicare and Medicaid Services (CMS) and other changes that hurt MA’s ability to save and reinvest in physician payments and benefits.

#medicareadvantage #medicare #healthplans #providers

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Incredible Study On Drugs Selected For Medicare Drug Negotiations: Their Prices in America vs. Other Developed Nations

A new Commonwealth Fund study finds that the list prices for the ten drugs selected for Medicare price negotiations are about three times higher in the United States than in other developed countries. Even after rebates and discounts, prices are higher than other countries, with the exception of Xarelto. How do brand drug makers justify this?  Study here: https://www.commonwealthfund.org/publications/2024/jan/how-prices-first-10-drugs-medicare-negotiations-compare-internationally?check_logged_in=1

#drugpricing #rebates #ira

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Walgreens CEO Bullish On Primary Care

Walgreens CEO Tim Wentworth says he is bullish on primary care even as the company pulls back on an earlier expansion.  He also stated that he is not interested in owning a PBM after one was solid many years ago now. He also said coverage losses due to Medicaid redeterminations are hurting pharmacies.

(Article may require a subscription.)

#walgreens #primarycare #retailhealthcare #pbms

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Elevance Health Buys Paragon Healthcare

More news that health plans are looking to vertically integrate with key providers and entities.  Elevance Health, which operates Blue Cross Blue Shield plans in 14 states, will pay an undisclosed sum to acquire infusion services provider Paragon Healthcare, owned by a private equity firm currently.

(Article may require a subscription.)

#healthplans #elevancehealth #acquisitions

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CVS Gives Biosimilars Traction

Great development on the biosimilar front.  CVS is removing Humira from its commercial formularies in favor of covering biosimilars starting April 1. Brand drug maker AbbVie has prevented biosimilars to Humira from gaining market share, but this is a breakthrough. Capitol Hill wants biosimilar reform to pass as well. CVS says costs for consumers could drop by more than 50%.

(Article may require a subscription.)

#biosimilars #drugprincing

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KHN Article Details Plight of Consumer Regarding Expensive Infusion Drugs

This is one in an occasional series from Kaiser Health News (KHN) on prior authorization denials. It puts insurers in a bad light for sure.

#priorauthorization #healthplans

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New Survey Suggests Medicaid Disenrollees Made No Effort To Renew

A Utah government survey finds that 57% of those disenrolled in the state through the Medicaid redetermination process (which began in April in most states) did not make an effort to renew their coverage. Most have been disenrolled on procedural grounds. Most reported paperwork challenges for abandoning attempts to renew. About 54% of the disenrollees surveyed found coverage through an employer or the Exchanges.  That still means many remain uninsured.

#medicaid #redeterminations #uninsured #uninsuredrate

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Troubled By NPR And KHN Article on Medicare Advantage

You know I am a fan of Kaiser Health News (KHN), but am always amazed by these periodic attacks on Medicare Advantage (MA). I see this article as incredibly one-sided and it seems to harp on a small subset of concerns. It seems driven too by the provider lobbying campaign. Plans have to watch for these pieces and push back.

A few pushbacks on my part:

–On prior authorization, network requirements and other constraints — these difference between the traditional Medicare fee-for-service (FFS) program and MA are well publicized in materials. Most people are highly satisfied with their plans and the value they bring. There are always trade-offs. It is hard to imagine that many folks end up paying more in the traditional program than MA.

— Some of the issue here is rural areas and perhaps low-rate areas. This is not the case more broadly in America. As well, it seems Capitol Hill and the Centers for Medicare and Medicaid Services (CMS) are on a campaign to undermine MA, which will hurt further expansion into under-served areas.

— In discussions of major churn in MA, it is hard for me to reconcile what is being said with the tremendous growth in MA over the past several years. And it could be the free market allowing people to hop to better deals. Certainly the numbers do not show traditional FFS growing by taking an inordinate amount of disenrollees and new entrants to Medicare.

— On switching back, of course traditional Medicare is more expensive. The point on Medicare Supplement is a fair one and better regulation around enrollment and acceptance could occur. And again, I find it hard to believe that the great growth in MA is because so many are trapped in MA. Customer satisfaction does not show this.

— Why couldn’t the article find a case of someone who is delighted with the value MA brings and how it provides a safety net for lower and middle income Americans? Because they didn’t want to.

#khn #medicareadvantage #medicare

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— Marc S. Ryan

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