Trump Seeks To Make Medicare Drug Price Negotiations Permanent In Regulation
The Trump administration and the Centers for Medicare & Medicaid Services (CMS) have proposed to codify the Biden-era Medicare Drug Price Negotiation Program — a fantastic turn of events that few would have predicted a few years ago despite Trump’s sympathies for drug price reform. They say the move will create a more transparent and sustainable process for lowering drug costs for millions of Medicare beneficiaries. There are a number of small concessions to drug makers as well.
I have given President Trump great credit for making a huge impact on drug pricing, more than any other recent president. This is more evidence.
Additional articles: https://www.cms.gov/newsroom/press-releases/cms-proposed-rule-locks-lower-prices-fosters-innovation-medicare-drug-price-negotiation-program and https://www.cms.gov/files/document/mdpnp-nprm-fact-sheet.pdf
#drugpricing #cms #medicare #partd #medicareadvantage #pdp
Democrats Search For The Next Obamacare
Democrats are seeking to find their next Obamacare to win votes in the midterms. Lawmakers and policymakers are focusing on the tired Medicare for All proposal, various Medicare Choice proposals (which generally would allow employers to enroll employees in Medicare), and a Healthcare Bill of Rights.
#healthcare #healthcarereform
https://thehill.com/policy/healthcare/5920779-healthcare-reforms-democratic-momentum/
Express Scripts Sues Tennessee
After CVS decided to sue Tennessee, Express Scripts is now entering the fray. Both oppose a state law that bars PBMs from also owning pharmacies in the state. In its complaint, Express Scripts says that policy would not just impact retail pharmacies but would force its parent company, Evernorth, to shutter an Accredo specialty pharmacy center based in Memphis.
#pbms #drugpricing #pharmacies #healthplans
https://www.fiercehealthcare.com/payers/cvs-sues-challenge-tennessees-new-pbm-law
FTC To Settle Insulin Case With Last of the Big 3 PBMs
The Federal Trade Commission (FTC) is settling with the last of the big 3 pharmacy benefits managers (PBMs) over antitrust allegations involving insulin pricing. Court documents suggest the agency has reached an agreement with Optum Rx, after deals with Express Scripts and CVS Caremark.
Additional articles: https://www.fiercehealthcare.com/payers/optum-rx-ftc-posed-settlement-insulin-pricing-case and https://www.healthcaredive.com/news/unitedhealth-optum-rx-ftc-proposed-settlement-insulin-case/822857/
(Some articles may require a subscription.)
#pbms #ftc #antitrust
https://www.modernhealthcare.com/insurance/mh-ftc-optum-rx-pbm-insulin-rebate-settlement
Judge Tosses Pieces of Exchange Rule
A federal judge struck several parts of a health insurance exchange enrollment and eligibility rule that went into effect for the 2026 plan year. The same judge earlier stayed the enforcement of most of the provisions.
The judge says CMS lacked the statutory authority to enact a $5 premium penalty on auto-reenrollments, shorten the enrollment period and lessen plans’ required coverage value. The decision also stops eligibility checks ahead of special enrollment periods, eliminating guaranteed insurance coverage for individuals with past-due premiums, and requiring exchanges to verify certain household income data.
The opinion also strikes a provision that disqualifies people for advance payment of subsidies if they didn’t file income taxes and failed to reconcile their tax credits in a previous year. Further, it also rescinds the elimination of a 60-day window for enrollees to resolve household income data. This was the only policy that ever went into effect for the 2026 plan year.
(Article may require a subscription.)
#exchanges
https://www.modernhealthcare.com/insurance/mh-aca-enrollment-eligibility-rule-blocked-judge
OIG: MA Plans Deny Care For Profit
The Health and Human Services Office of Inspector General (HHS OIG) says major Medicare Advantage (MA) insurers appear to deny care for profit. Analyses in two reports says MA insurers commonly deny requests for post-acute care, especially UnitedHealth, Humana and CVS Aetna. Health plans deny the conclusions are valid, but big plan denial rates appear to be well above smaller ones.
Of note: many of the denials were overturned on appeal. The OIG suggests they should have been approved in the first place.
#fwa #priorauthorizations #denials #healthplans
CA May Fill In Subsidy Losses With State Dollars
Gov. Gavin Newsom is negotiating a final budget with the legislature and a proposal would offer financial help to more than 1 in 4 enrollees in Covered California, the nation’s largest state-run Exchange. Some Democrats in the legislature want to go even farther than Newsom’s proposal.
#exchanges #ca #subsidies
— Marc S. Ryan
