March 19, 2024

Elevance Health To Buy Kroger Specialty Pharmacy

In an effort to further build out its Carelon service subsidiary, Elevance Health is buying Kroger Specialty Pharmacy.  This will add to its growing PBM offerings.

Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-acquire-kroger-specialty-pharmacy and https://www.modernhealthcare.com/finance/elevance-health-carelonrx-kroger-specialty-pharmacy

(Some articles may require a subscription.)

#kroger #elevancehealth

Link to Article

ERISA Update RFI Means Battle Lines Drawn

A House committee issued a request for information to see how the employer self insurance laws (ERISA) should be updated after 50 years.  Providers of course are asking for major regulation, while employers want to ensure pre-emption of state laws. Abandoning pre-emption would add demonstrably to costs.  ERISA provides the most coverage in America and it should not be played with.

#erisa #coverage #employers #providers

Link to Article

PBM Reform Dead For Now

No deal could be reached on pharmacy benefit manager (PBM) reforms despite bipartisan support in each house of Congress.  Reforms will need to wait until post-election. The big three PBMs are delighted.  Some reforms would have gone too far, but some changes, such as banning spread pricing, were sensible.

(Article may require a subscription.)

#pbms #drugpricing

Link to Article

Change Healthcare Could Lose Business, But How Much?

The article updates on current statuses but also raises the issue of how much Change could lose with the cyber attack.  It does shine a light on too much consolidation.  Some competitors are stepping in to rescue plans and providers and take some of the Change business.  But some argue that Change has too many tentacles.  I tend to disagree.  I think health plans will rethink how they contract with vendors. I think Change’s losses could be significant over time.

(Article may require a subscription.)

#changehealthcare #cyberattacks

Link to Article

Prominent Insurers Abandoning ACO REACH

The nation’s biggest Accountable Care Organization (ACO) is losing prominent health plan backers.  Insurers team up with providers to form the ACOs and some major plans are backing out with the rise in medical expenses.  These plans have a lot going on with rising medical expense in the Medicare Advantage (MA) program with a foolish change by the Centers for Medicare and Medicaid Services (CMS) on prior authorization (PA).

At the same time, CMS has just announced yet another Medicare fee-for-service (FFS) pilot.  The model in essence grants additional funding (one-time and monthly capitation) to primary care physicians in ACOs.  Seems a bit crazy. Isn’t this what the ACOs should be doing? Seems like a Band-Aid on a program that does not seem to be living up to expectations.  More administration and overlap in the FFS program. If FFS is to stay, invest in a small number of rational investments.  There are far too many, causing confusion and a great deal of expense.

New primary care program: https://insidehealthpolicy.com/daily-news/cms-debuts-new-aco-lauded-primary-care-model and https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-new-initiative-increase-investments-person-centered-primary

(Some articles may require a subscription.)

#acos #medicare #pilots #healthcarereform

Link to Article

Good Article On Status Of Lawsuits Against Medicare Drug Price Negotiations

Good article explaining where all the litigation against the Medicare drug price negotiations are.  Put simply – the brand drug makers appear to be losing badly so far.

#ira #drugprices #branddrugmakers

Link to Article

KFF Issue Brief Explains The No Surprises Act From A Patient’s Standpoint

A good issue brief from the Kaiser Family Foundation (KFF) on the rights and process that people have regarding surprise bills under the No Surprises Act. It is complicated. 

#nsa #nosurprisesact #surprisebilling

Link to Article

— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now