Hard-Hitting Study Could Drive Medicaid Budget Cuts
A study by the Paragon Health Institute and the Economic Policy Innovation Center could help drive certain cuts adopted by Republicans during the budget reconciliation process. The study focuses in on California and various ways the authors say the Golden State effectively exploits matching rules and launders money to fund its state share at the expense of the federal Medicaid budget. It also indicates that the schemes provide dollars to cover undocumented immigrants, even though federal law bars enrollment in Medicaid.
The GOP in Congress is known to want to stay away from explicit coverage reductions in Medicaid. But it is looking at reining in the amount states are demanding in match as well as eliminating or at least reducing the use of provider taxes for state match.
#medicaid #healthcare #coverage #budgetreconciliation
GLP-1 Spending Outpaces Specialty Drugs
Spending on GLP-1 drugs continues to rise, outpacing even trends in specialty drugs for the first time in 2023. GLP-1s were approved in 2021 for chronic weight management. Since then, drug spend growth rates rose from 2.1% in 2021 to 12.8% in 2024.
Additional article: https://www.fiercehealthcare.com/payers/evernorth-study-spending-growth-glp-1s-outpacing-specialty-pharmacy
#drugpricing #pbms
CMS Increasing Price Transparency Oversight
With the Trump administration issuing an executive order, the Centers for Medicare and Medicaid Services (CMS) has already begun greater enforcement against health systems for not complying with price transparency rules. The actions are greater already than all of 2024, but the size of the penalties is dropping.
(Article may require a subscription.)
#pricetransparency #healthplans #hospitals
https://www.modernhealthcare.com/providers/cms-price-transparency-rule-enforcement
Oz Gets Endorsed By Senate Finance Committee
Dr. Mehmet Oz received the endorsement of the Senate Finance Committee as the next head of the Centers for Medicare and Medicaid Services (CMS). The vote was 14-13 along party lines. Oz has taken positions on a number of topics that were surprising, including supporting Medicare drug price negotiations, making GLP-1s and insulin more affordable, ending drug shortages, and march-in rights on drug patents.
In other news, the Senate confirmed health researcher Jay Bhattacharya as the next leader of the National Institutes of Health (NIH). Bhattacharya was confirmed on a party-line vote, 53 to 47.
Additional articles: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/oz-says-he-ll-work-glp-1-affordability-doesn-t-show-hand-biden-rule and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/oz-signals-interest-tackling-drug-shortages-insulin-coverage and https://insidehealthpolicy.com/daily-news/oz-open-considering-march-rights-vague-ira-issues and https://www.fiercehealthcare.com/payers/oz-confirmation-vote-advances-out-senate-finance-committee and https://www.medpagetoday.com/publichealthpolicy/medicare/114825 and https://thehill.com/policy/healthcare/5213872-jay-bhattacharya-senate-confirmed-nih/
(Some articles may require a subscription.)
#oz #cms #trump #healthcare #drugpricing
https://thehill.com/policy/healthcare/5212230-dr-mehmet-oz-cms-confirmation
Review of Federal And State Efforts On Prior Authorization and Claims Denials
Stateline has an interesting article on federal and state efforts to reduce the use of and streamline prior authorizations and to reduce unwarranted claims denials.
#healthcare #priorauthorization #claimsdenials #healthplans
— Marc S. Ryan
