Senate Deal On Private Coverage Insulin Costs
Sens. Jeanne Shaheen, D-NH, Susan Collins, R-ME, Raphael Warnock, D-GA, and John Kennedy, R-LA, reached a deal to limit out-of-pocket costs for people with diabetes by waiving any deductibles and limiting cost sharing to the lesser of $35 or 25 percent of the list price per month. This could lead to the passage of the legislation in the upper chamber.
The bill would also require pharmacy benefit managers (PBMs) to pass through 100% of insulin rebates and other compensation to insurers. A pilot program in 10 states would also be set up to identify uninsured people with diabetes and providing them with $35 monthly insulin.
#drugpricing #insulin #diabetes
https://thehill.com/policy/healthcare/5800233-insulin-cost-cap-legislation
MA Marketing Lawsuit To Proceed
A civil whistleblower lawsuit against CVS Health subsidiary Aetna, Elevance Health and Humana alleging kickbacks to online brokerages for Medicare Advantage (MA) enrollments will proceed. The Justice Department has joined the suit. The three insurers are alleged to have paid hundreds of millions of dollars to eHealth, SelectQuote and GoHealth for steering customers to their plans. The plaintiffs also say Aetna and Humana paid brokers to limit sign-ups of enrollees with disabilities.
(Article may require a subscription.)
#medicareadvantage #marketing
https://www.modernhealthcare.com/insurance/mh-aetna-humana-medicare-advantage-marketing-lawsuit
Contract Disputes Rising
Contract disputes between insurers and health system networks are rising. Providers are demanding rate increases due to high costs and relief from prior authorizations (PAs) and other burdens. Health insurance companies are implementing tougher PAs in some cases and attempting to limit the cost of care.
(Article may require a subscription.)
#healthplans #hospitals #providers
https://www.modernhealthcare.com/insurance/mh-cvs-health-ftc-insulin-rebate-lawsuit
Providers Want Health Product Design Provisions Discarded
Hospital and physician groups want the Centers for Medicare and Medicaid Services (CMS) to eliminate or rework its plans for the health insurance Exchange products. They called out to main problems – expansion of high-deductible catastrophic plans and non-network benefit plans as qualified in the Exchanges. The groups argue the proposals will erode revenue and increase risk.
(Article may require a subscription.)
#exchanges #hospitals #physicians
https://www.modernhealthcare.com/politics-regulation/mh-cms-aca-exchanges-rule-providers
Work Requirements, Frequent Requalification Will Erode Enrollment
An Urban Institute analysis, funded by the Robert Wood Johnson Foundation, says that between 4.9 million and 10.1 million could be enrolled in Medicaid in an average month by 2028 due to the implementation of work requirements and more frequent requalification.
#medicaid #workrequirements #eligibility
— Marc S. Ryan
