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June 12, 2024

National Healthcare Spending Projections

The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary released its annual re-estimates of spending over a 10-year horizon.  While 2023 healthcare expenditures will be finalized in December, current estimates are that national healthcare spending grew by 7.5% in 2023 to about $4.8 trillion, or 17.6% of gross domestic product (GDP). Part of the costs were record coverage.

Medicare spending is projected to have grown 8.4% in 2023, with costs over $1 trillion. Private health insurance spending is expected to have increased 11.1%.  Medicaid spending is expected to have grown by 5.7%.  This is lower due to dropping enrollment.

National health expenditures will rise to $7.7 trillion and capture nearly one-fifth of the U.S. economy by 2032.

I will have a blog next week digging into all the stats.

Additional articles: https://www.modernhealthcare.com/policy/national-health-spending-projected-reach-77t-2032-cms and https://www.healthcaredive.com/news/national-healthcare-spending-growth-cms-report/718718/ and https://www.cms.gov/newsroom/press-releases/cms-releases-2023-2032-national-health-expenditure-projections

(Some articles may require a subscription.)

 #healthcare #costs

https://www.fiercehealthcare.com/finance/cms-projects-national-health-spending-grew-75-2023-48t

Providers, Lawmakers Want To Rein In Prior Authorization Even More

Despite major new prior authorization (PA) and interoperability rules from the Centers for Medicare and Medicaid Services (CMS), providers and lawmakers from both parties are pushing for the resurrection of a long-stalled Medicare PA reform bill.  It has a much better chance of passing now that the Congressional Budget Office (CBO) has scored the bill at zero cost.  Still, the additions will create even more challenges for MA plans. Lawmakers are captivated by the provider lobby. Sadly, the main advocacy group for MA, the Better Medicare Alliance (BMA), is backing the bill as well.

Additional articles: https://www.modernhealthcare.com/politics-policy/medicare-advantage-prior-authorizations-targeted-new-bill and https://insidehealthpolicy.com/daily-news/ama-urges-prior-auth-reform-lawmakers-prepare-push-long-awaited-bill and https://insidehealthpolicy.com/daily-news/marshall-reintroduces-bill-streamline-ma-prior-auth-zero-cost-estimate-cbo and https://bettermedicarealliance.org/news/better-medicare-alliance-endorses-modernize-prior-authorization/

(Some articles may require a subscription.)

#bma #medicareadvantage #priorauthorization  

https://www.fiercehealthcare.com/payers/ama-lawmakers-aim-prior-authorization-crackdown-insurers

AHIP Conference Discusses Barriers To Biosimilar Adoption

The AHIP conference had a session on biosimilar adoption, where many of the barriers to widespread adoption were discussed, including interchangeability and member and provider education.

#drugpricing #biosimilars #healthcare

https://www.fiercehealthcare.com/payers/ahip-2024-hurdles-widespread-biosimilar-adoption

Elevance Health Sees Opportunity in 2025 In MA

Joining giant United Healthcare, Elevance Health is now saying they see opportunity on 2025 in Medicare Advantage (MA).  It is fresh off a victory on Star revenue and also already reduced benefits going into 2024.

(Article may require a subscription.)

https://www.modernhealthcare.com/insurance/elevance-health-medicare-advantage-goldman-sachs-conference

Coverage of GLP-1s For Weight-Loss Drugs Tightening

While some plans are expanding GLP-1 access for weight loss alone, BCBSMI is ending coverage in full risk commercial plans. 

Blue Cross Blue Shield of Michigan will drop coverage GLP-1 obesity drugs in fully insured large group commercial plans. In a new analysis, The Peterson-KFF Health System Tracker is reporting GLP-1 coverage for disease states but very little coverage for weight-loss alone in the Exchange program.

Additional article: https://www.modernhealthcare.com/insurance/blue-cross-blue-shield-michigan-weight-loss-drug-coverage-glp-1s-wegovy

(Some articles may require a subscription.)

#weightlossdrugs #drugpricing #exchanges

https://www.healthsystemtracker.org/brief/insurer-strategies-to-control-costs-associated-with-weight-loss-drugs/

MACPAC Wants States To Report State Funding For Medicaid Match

MACPAC, the congressional policy arm, is asking Congress to force states to show how they fund Medicaid to draw down federal match.  As a former state budget director, I can tell you that states engage in various levels of skullduggery to find state matching dollars in Medicaid. Some of it is downright unseemly.  While some of the ugliest match schemes have been closed down, there is plenty more to reform. This is a fair ask by MACPAC.

#medicaid #cms

https://www.healthcaredive.com/news/macpac-state-transparency-medicaid-financing-provider-taxes-sdps/718630

House Committee Advances PBM Reforms

The House Energy and Commerce Committee has advanced reforms on pharmacy benefits managers (PBMs), including a ban on spread pricing and limiting income to administrative fees tied to fair market value.

(Article may require a subscription.)

#pbms #drugpricing

https://insidehealthpolicy.com/daily-news/ec-passes-pbm-reforms-stark-law-bill-rare-disease-bill-still-priority

Generic Cancer Drug Had Huge Savings For Highmark

A generic prostate cancer medication saved Highmark members $90 per month on average and generated $3 million in savings for the plan, members and group customers. An amazing case study.

#generics #drugpricing

https://www.beckerspayer.com/payer/generic-cancer-drug-drove-3m-in-savings-for-highmark.html

— Marc S. Ryan

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