March 7, 2024

Almost 18 Million Initially Lost Medicaid Coverage During Redeterminations

The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations.  Some regained eligibility later.  Most lost coverage on procedural grounds.  Enrollment has dropped by about 10M so far in Medicaid nationwide.

#medicaid #redetermintations

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Evernorth Continues Growth

Cigna’s Evernorth service subsidiary continues its growth. It announced an expansion to its GLP-1 management solution as well as the launch of a new behavioral-health-focused medical group.

#cigna #evernorth

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Biden To Propose Major Expansion Of Healthcare Initiatives

President Biden will propose major healthcare expansions in his State of the Union Address tonight.  Among other things, a Fact Sheet says he will propose an expansion of Medicare drug price negotiation (500 drugs negotiated over the next 10 years), permanent expansion of enhanced premium subsidies in the Exchanges, a special program for those in the coverage gap, a $2,000 annual cap on drug cost-sharing in commercial products, a $35 per month insulin cap in commercial products, and extension of inflation drug rebates to commercial as well. 

White House Fact Sheet here: https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/06/fact-sheet-president-biden-takes-new-steps-to-lower-prescription-drug-and-health-care-costs-expand-access-to-health-care-and-protect-consumers/

Additional articles: https://www.healthcaredive.com/news/biden-medicare-expand-drug-pricing-ira/709619/ .

#ira #drugpricing #aca #exchanges #coveragegap

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GOP Wants Medicare Fraud Investigation

Leading House Republicans want the Health and Human Services Inspector General to open a fraud investigation into recent allegations of illegal catheter billing scheme impacting Medicare and accountable care organizations (ACOs). There have been a number of fraud investigations and charges relating to other medical equipment.

#medicare #fwa

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Cuban Firm Scores Contract With Major Hospital System

Showing how much can quickly change in the drug world, Mark Cuban’s Cost Plus Drugs has inked a deal with Community Health Systems to supply it with pharmaceuticals like epinephrine and norepinephrine for its affiliate hospitals in Texas and Pennsylvania. Cuban is entering the manufacturing business here. The traditional drug channel has to be quaking in its boots with this announcement.

Additional article: https://www.fiercehealthcare.com/providers/mark-cuban-cost-plus-drug-company-selling-directly-community-health-systems

(Some articles may require a subscription.)

#drugpricing #transparency

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ICHRA Projected To Expand

Good article on growth projections for individual coverage health reimbursement arrangements (ICHRA), where employers contribute toward individual coverage on a tax-deductible basis.  It is projected to grow over time.  I think it is one of the wisest things out there.  It will pair with the individual Exchanges well.  It is ironic that former President Trump backed ICHRA but wants to repeal the Affordable Care Act (ACA) at the same time.

#aca #obamacare #exchanges #ichra

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Study Finds Utilization Management Grew In Part D

A recent study finds that utilization management restrictions in Medicare Part D standalone plans (PDPs) became more restrictive over the last decade.  They were more restrictive than Medicare Advantage (MA) Part D plans. In the first case, PDPs are plans for those in traditional Medicare and a small subset of Medicare Advantage plans without drug coverage.  In the second case, MA plans offer both medical and drug coverage in one plan. Prior authorization, step therapy and formulary exclusions all increased between 2011 and 2020.

#pdp #partd #medicare #priorauthorization

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Drug Maker Reduces Costs Of Inhalers

Drugmaker Boehringer Ingelheim will cap the out-of-pocket costs for its inhalers at $35 per month. It will target the relief to those with employer-sponsored insurance and underinsured and uninsured.  It will begin June 1.

While the relief is welcome, there is little doubt that the drug makers (in this case and regarding insulin some months back) would never have done anything if not for the actions of prominent Democrats investigating high prices and criticizing brand drug makers. 


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Good Article On The Change Healthcare Impacts To Providers

Another good article on the Change Healthcare cyber attack and the impact on providers.  Lawsuits continue to pile up, arguing Change was not ready for a cyber attack and the nationwide impact it caused. I have many friends in the health plan world and all tell me this is having a devastating effect on their business, whether providers or health plans.  All seem to be looking for alternatives.  This could spell doom for Change as well as Optum in general.  The provider and health plan world will no longer trust that large organizations can react fast or have their backs.  They seem to believe that billions in resources does not mean readiness or accountability. Once these plans and providers find alternatives, they will not come back.

(Article may require a subscription.)

#changehealthcare #cyberattacks #healthplans #providers #hospitals

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Major Drug Price Lawsuit Begins

While some drug price lawsuits have been tossed, a major one brought by brand drug makers has now begun. Drug makers Bristol Myers Squibb, Johnson & Johnson, Novartis, and Novo Nordisk had an army of lawyers arguing their case on constitutional and regulatory grounds in a court room today in New Jersey.

So far, the likelihood of success looks somewhat remote.

(Article may require a subscription.)

#ira #drugpricing

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— Marc S. Ryan

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