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June 26, 2024

Quarterly Drug Inflation Rebate Caps Save More Dollars For Medicare And Enrollees

The Centers for Medicare & Medicaid Services (CMS) announced 64 new drugs subject to quarterly caps because price increases exceeded allowable inflation. This will mean additional rebates and lower out-of-pocket costs for 750,000 enrollees. The provision was passed as part of Medicare drug price negotiations in the Inflation Reduction Act (IRA).

In addition, states increasingly are passing protections on drug manufacturers limiting 340b discounts to certain providers.  This came after the Supreme Court upheld such state laws. I do not agree generally with the ruling as it perpetuates an abuse of 340b’s intent.

Additional articles: https://thehill.com/policy/healthcare/4740963-biden-lower-prescription-drug-costs-medicare-inflation-reduction-act/ and https://www.modernhealthcare.com/supply-chain/340b-drug-program-discounts-arkansas-missouri-laws

Press Release Here: https://www.cms.gov/newsroom/press-releases/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-rebate-program-established-biden

(Some articles may require a subscription.)

#drugpricing #ira #medicare #partd #pdp #medicareadvantage

https://www.fiercehealthcare.com/payers/hhs-lowers-64-prescription-drug-prices-under-medicare-rebate-program

Sen. Wyden Wants CMS To Protect Small Independent Pharmacies

Senate Finance Chair Ron Wyden, D-OR, is asking the Centers for Medicare & Medicaid Services (CMS) to better enforce Medicare Part D program requirements for pharmacy benefit managers (PBMs), arguing policies are threatening small independent pharmacies. Wyden has singled out Express Scripts. Another provision of the Medicare drug price negotiations has created cash flow issues for small pharmacies.

In other news, Arkansas has sued Optum and Express Scripts over the opioid epidemic.

Additional articles: https://www.fiercehealthcare.com/payers/arkansas-files-opioid-lawsuit-against-optum-express-scripts and https://www.healthcaredive.com/news/arkansas-sues-optum-express-scripts-opioid-epidemic/719731/

#ira #medicare #partd #pharmacies #opioids

https://www.fiercehealthcare.com/payers/wyden-blasts-express-scripts-pricing-tactics-asks-cms-intervene

Healthcare Deals Holding Own In 2024 Despite Financial Pressures

Audit and consulting firm PwC says that, despite financial headwinds in the industry and high interest rates, healthcare deal volumes in 2024 are largely consistent with those seen in 2023 and remain above pre-COVID levels.

#healthcare #manda #financing

https://www.fiercehealthcare.com/finance/pwc-dealmaking-activity-healthcare-shows-stability-early-2024

AHA Opposes Nursing Home Staffing Standards

The American Hospital Association (AHA) is opposing the nursing home staffing rule promulgated by the Biden administration due to workforce shortages.  It could impact hospitals greatly too.  The rule was a blatant political sop to labor unions during an election year and is unrealistic.  It could mean the shuttering of smaller nursing homes and a massive consolidation in the industry.

(Article may require a subscription.)

#nursinghomes #staffing

https://www.modernhealthcare.com/politics-policy/aha-backs-congressional-bid-repeal-nursing-home-staffing-rule

Group Issues Draft Standards On AI Use In Healthcare

The Coalition for Health AI has issued a draft framework and standards for the safe deployment of artificial intelligence in healthcare.

#ai #healthcare

https://www.healthcaredive.com/news/coalition-for-health-ai-chai-standards-framework/719970

House Committee Could Consider Limited Medicare Coverage Of GLP-1s For Obesity

While costs of GLP-1s are increasing dramatically in Medicare for GLP-1s for disease states and conditions, the House Ways and Means Committee could consider limited Medicare coverage of GLP-1s just for weight loss. Beneficiaries who were prescribed the drug for at least a year before switching to Medicare could continue coverage. I doubt this will become a law given it would serve as a foot in the door and drive much higher costs.

#weightlossdrugs #medicare #partd #pdp #medicareadvantage

https://www.beckerspayer.com/policy-updates/house-committee-considers-limited-medicare-coverage-of-weight-loss-drugs.html

Hospital Mergers Lead To Layoffs

Joining the negatives of higher prices and no increase in quality, a new study finds that hospital mergers also lead to increased layoffs and lower tax revenues.

In other news, for-profit hospitals had worse grades on an index measuring equity, care value and patient outcomes.

Additional article: https://www.healthcaredive.com/news/for-profits-performed-worse-most-socially-responsible-hospital-ranking-lown-institute/719723/

#manda #mergers #acquisitions #hospitals

https://www.healthcaredive.com/news/hospital-mergers-tied-to-increased-layoffs-reduced-tax-revenues-report/719882

Chevron Deference Could Be Overturned Or Substantially Curtailed

This week the Supreme Court is expected to overturn or substantially curtail the so-called Chevron Deference. The provision that when a legislative delegation to an administrative agency on a particular issue or question is not explicit but rather implicit, a court may not substitute its own interpretation of the statute if a reasonable interpretation is made by the administrative agency. Courts have reined in this liberal precedent somewhat, but the Supreme Court’s ruling could have massive consequences. Agencies have relied on the deference to promulgate sometimes far-reaching rules, including in healthcare.  Healthcare advocates fear the ruling as it could mean less aggressive healthcare rules in the future. Others argue it will return rule-making to a more reasonable standard. A report from the Paragon Health Institute argues that agencies should adopt good guidance practices (GGPs) to force agencies to be more transparent in rule-making.

Additional article: https://insidehealthpolicy.com/daily-news/chevron-decision-looming-paragon-says-good-guidance-practices-should-be-reinstated

(Articles may require a subscription.)

#healthcare #rulemaking #chevrondeference

https://insidehealthpolicy.com/health-insider/chevron-emtala-decisions-deck-scotus-debate-week-arrives

Drug Makers Oppose Importation

Aggressively defending its turf, brand drug makers and other parties are opposing the expansion of drug importation.  Colorado is one of a number of states that has received or is requesting the ability to import drugs from Canada under a Trump-era rule. The groups say Colorado’s application has procedural issues, is not germane, and would mean risks to patients and their confidentiality. Colorado wants to import 24 drugs. Canada opposes such schemes as it could impact their drug supplies.

(Article may require a subscription.)

#drugimportation #canada #co

https://insidehealthpolicy.com/daily-news/pharma-insurance-groups-ask-fda-nix-co-drug-importation-plan

Get Out The Popcorn And Danish: Drug Executive On Capitol Hill

Get out the popcorn and danish. Be ready for fireworks. Denmark-based Novo Nordisk Global CEO Lars Fruergaard Jorgensen will appear before the Senate HELP Committee and Chairman Bernie Sanders.  Sanders has made it a point to highlight the high prices of weight-loss drugs Ozempic and Wegovy in the U.S. vs. other developed countries as well as the modest cost of production.

(Article may require a subscription.)

#weightlossdrugs #drugpricing #branddrugmakers

https://insidehealthpolicy.com/daily-news/novo-nordisk-ceo-testify-sept-24-ozempic-wegovy-prices

Ozempic Face: Weight-Loss Drugs Generating Plastic Surgery

In a striking example of what is wrong with healthcare, a study reports that the obsession with weight-loss drugs despite astronomical prices is leading to another major healthcare trend – plastic surgery to remove excess skin, lifts, tucks, and fillers.

In other news, a study shows that a weight-loss drug could pose a risk to bone health.

Additional article: https://www.bloomberg.com/news/articles/2024-06-25/weight-loss-drug-saxenda-reduced-bone-density-health-in-study

#weightlossdrugs #healthcare #drugpricing #branddrugmakers

(Articles may require a subscription.)

https://www.bloomberg.com/news/articles/2024-06-25/extra-skin-from-ozempic-weight-loss-spurs-plastic-surgery-boom

Forefront Blog On Ending Unequal Treatment In Healthcare

Good Health Affairs Forefront Blog on reversing unequal treatment in healthcare.  Among recommendations include Medicaid expansion in the ten recalcitrant states and fixing inequitable Medicaid reimbursement in U.S. territories.

(Article may require a subscription.)

#healthequity #healthcare #medicaid

https://www.healthaffairs.org/content/forefront/ending-unequal-treatment-united-states-health-care-system

— Marc S. Ryan

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