March 25, 2024

Biden Signs Funding Bill

President Joe Biden signed a $1.2 trillion spending package on Saturday, avoiding a government shutdown. The package includes funding for the Department of Health and Human Services (HHS). The Senate passed the measure 74-24, technically after the deadline.

Additional article: https://www.modernhealthcare.com/politics-policy/spending-bill-passes-hhs-funding

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#governmentshutdown #spending #healthcare

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Change Ready To Turn On Last Major Products Involving Claims

UnitedHealth Group said that its largest clearinghouse, called Relay Exchange, will be back online this weekend.  Further, after testing by clients, $14 billion in medical claims will be processed through a system. It also unveiled a timeline for remaining products to come online – roughly through mid-April.

Another article speaks to a new bill that would open up funding during cyberattacks if providers have met certain cyber standards. As well, the American Hospital Association (AHA) is opposing proposals that would tie cyber standards to Medicare reimbursement: https://www.modernhealthcare.com/politics-policy/change-update-cybersecurity-improvement-act-2024

Additional article: https://www.healthcaredive.com/news/change-healthcare-cyberattack-systems-online-mid-march-unitedhealth/709739/

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#changehealthcare #cyberattacks

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Humana Moves To Have AI Lawsuit Dismissed

Humana has asked that a class action lawsuit filed by two Medicare members be dismissed, arguing that it did not use artificial intelligence to automatically deny post acute care claims.

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#humana #ai #claimsdenials

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States Move To Enforce Site-Neutral Policies With Fed Delay

Many states are intervening and passing laws related to site-neutral payment policies.  This comes as delays in passing a federal bill occur. Last year, four states passed laws restricting so-called facility fees related to hospitals and hospital-owned facilities. Eight others may pass laws on the subject. Not all bills have or will fully bar all payment differences.  But this is a clear blow to the hospitals.  It is fair to reimburse and ask patients to pay the same rates for the same services regardless of locations.

(Article may require a subscription.)

#siteneutral #hospitals

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FTC Fighting Teva On Patent Disclosures

The Federal Trade Commission (FTC) is intervening in a lawsuit between Teva Pharmaceutical and a rival generic drug maker over Teva’s Orange Book patent listings on inhaler products. The FTC argues that Teva’s ongoing Orange Book listings are inappropriate and are stopping the timely introduction of generic inhalers. Teva may lower inhaler prices, but the ongoing Orange Book filings have major significance for generic introduction overall. As is often the case with Brand Pharma companies, Teva a is a foreign (Israeli) company attempting to keep prices high for American consumers.

(Article may require a subscription.)

#brandrugmakers #patents #drugpricing

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Biden and Dems Attack Republican Proposals On Medicare Reform

Democrats have come out swinging in this election year on a conservative House Republican Study Committee proposal that would reform Medicare due to its pending insolvency.  One portion calls for a premium support model, whereby seniors and the disabled use a subsidy to access healthcare privately or through traditional Medicare.  The report does not choose a scenario and previous Congressional Budget Office (CBO) analysis indicated that at least one scenario (average premium) would not hurt but potentially help enrollees.

The Democratic attacks are irresponsible.  They do not have a plan other than taxes to stabilize anything but the drug benefit (through negotiations).  I don’t agree with everything the House GOP has proposed, but the House GOP is at least putting ideas on the table to save the Part A Trust Fund and Medicare generally, which will be insolvent by 2031 and would trigger an 11% across-the-board cut to the Medicare payments.

I outlined some ideas on Medicare reform from my book, The Healthcare Labyrinth (available at this site) here: https://www.healthcarelabyrinth.com/the-trump-biden-great-entitlement-debate/

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#medicare #entitlements #healthcare #healthcarereform

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Bill Of The Month Shows How Outrageous Air Ambulance Bills Are

Kaiser Health News’ Bill of the Month tells of a family who was urged to use an air ambulance to lift their ill daughter to a specialty center.  Now, the $97,000 bill has been deemed medically unnecessary by the insurer.  The air ambulance, backed by private equity, will not bill reasonably.  And the provider that made the recommendation has basically stayed out of the fray and will not help the family.  The No Surprises Act (NSA) technically does not help here as the plan says the service was not necessary. Everything in this article smacks of meeting the prudent layperson standard in emergency situations.  Here is hoping an external review will rule sensibly.

Before the NSA, plans could simply indicate that air ambulance was out-of-network (OON) and not be at risk for a bill. Now, under NSA, emergency air ambulance is covered as OON and lets plans and providers determine the money to be paid, with patients simply paying a cost-share defined by the plan benefit. Now that the expense has been transferred to plans, they are scrutinizing these services to get out of coverage by deeming them not necessary (essentially not an emergency).  It is an NSA loophole and should be closed.  While I favor PA generally and have been supportive, in these emergencies health plans should have to presume medical necessity for inter-facility air transports ordered by a physician at a hospital.  It reasonably falls under prudent layperson standards.

#nsa #nosurprisesact #surprisebilling

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Eli Lily Says Two Insulins Will Be Out Of Stock And In Short Supply

Drugmaker Eli Lilly said that two of its insulins would be temporarily out of stock through the beginning of April. It is related to a manufacturing issue. Switching between brands can be problematic for some diabetics.

The federal government has to get its arms around drug shortages.  There is growing evidence that our opaque drug pricing system (with high prices) and lack of real competition have a big part to play.

#drugshortages #branddrugmakers

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GLP-1s Already Growing In Medicare

The Kaiser Family Foundation has found that costs for GLP-1 drugs are already growing in Medicare despite the prohibition on coverage of these drugs for obesity.  This is because the drugs can be Part D covered under some circumstances if someone has certain disease states and conditions, including diabetes and (soon) cardiovascular disease. In 2022, Medicare gross total spending reached $5.7 billion on Ozempic (semaglutide), Rybelsus (semaglutide), and Mounjaro (tirzepatide), all of which are covered for diabetes. Ozempic is now the sixth-highest Part D drug in terms of gross spending.

Analysis here: https://www.kff.org/policy-watch/medicare-spending-on-ozempic-and-other-glp-1s-is-skyrocketing/

Press release at link.

#weightlossdrugs #medicare #partd #pdp #medicareadvantage

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— Marc S. Ryan

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