HHS Explains MFN Drug Price Approach
The Department of Health and Human Services (HHS) issued guidance regarding President Donald Trump’s recent executive order regarding adopting most favored nation (MFN) drug pricing throughout the country.
If Big Pharma brand drug makers were not worried before, they should be now. An HHS press release laid out expectations for how drug makers will engage with the order. It notes all brand products that do not currently have generic or biosimilar competition across all markets (lines of business) are covered. It says drug companies must “commit to aligning” their U.S. prices with “the lowest price of a set of economic peer countries.” The peer group is the so-called rich nations as represented by the Organization for Economic Co-operation and Development countries and that have a gross domestic product (GDP) per capita of at least 60% of the U.S. GDP.
Big Pharma came out swinging, arguing the order could mean a pullback on planned American investments.
Critics came out again arguing there is no legal basis for the order, although the administration will pursue the policy through an experimental Center for Medicare & Medicaid Innovation (CMMI) model. It will likely face legal challenges.
Notwithstanding all this, Trump made the right move here to finally challenge Big Pharma. My blog on the topic: https://www.healthcarelabyrinth.com/trump-goes-all-out-on-drug-price-reform/ .
Additional articles: https://insidehealthpolicy.com/daily-news/trump-s-mfn-pricing-plan-likely-face-legal-hurdles-despite-cmmi-workaround and https://insidehealthpolicy.com/daily-news/hhs-most-favored-nation-scheme-include-only-brand-name-drugs and https://www.hhs.gov/press-room/cms-mfn-lower-us-drug-prices.html
(Some articles may require a subscription.)
#irp #mfn #drugpricing #trump
Trump Seeks To Close Reconciliation Bill
Donald Trump went to Capitol Hill today to meet House GOP members to urge them to pass the budget reconciliation bill. He told moderate Republicans from blue states to give up their fight over the state and local tax (SALT) deduction expansion beyond what is in the bill. Further, he told conservatives not to “f‑‑‑ with Medicaid.”
Some members said that Trump convinced the caucus, while some moderates and conservatives say they are still off the bill right now. His remarks to avoid deep Medicaid cuts except for eliminating waste, fraud and abuse goes against many conservatives still seeking deeper cuts, they want acceleration of work requirements as well as reduction in expansion population reimbursement. Speaker Mike Johnson seemingly took the latter off the table today.
In other news, healthcare policy group KFF shows how the uninsured rate will be impacted by state.
As well, some say that various administrative and legislative actions could reduce Exchange enrollment by one-third.
Additional articles: https://www.fiercehealthcare.com/payers/how-medicaid-reconciliation-bill-could-help-slash-aca-enrollment-one-third and https://www.modernhealthcare.com/politics-policy/trump-medicaid-gop-tax-bill and https://insidehealthpolicy.com/daily-news/johnson-says-fmap-change-not-table-conservatives-continue-push-work-requirements-speeded and https://thehill.com/homenews/house/5308397-gop-bill-medicaid-salt/?tbref=hp and https://www.kff.org/affordable-care-act/issue-brief/how-will-the-2025-reconciliation-bill-affect-the-uninsured-rate-in-each-state-allocating-cbos-partial-estimates-of-coverage-loss/ and https://www.beckershospitalreview.com/hospital-management-administration/dont-f-with-medicaid-trump-tells-gop-lawmakers/
(Some articles may require a subscription.)
#budgetreconciliation #trump #congress #medicaid #coverage
https://thehill.com/homenews/administration/5309356-trump-house-gop-bill-capitol
United Hit Hard In Optum By V28 Medicare Advantage Risk Model
More is coming out on the financial woes of UnitedHealth Group. Not only is its insurer hurting due to Medicare Advantage (MA) rate compression and utilization spikes, but its Optum services unit is also hurt by changes. Its physician groups’ risk deals have been hugely impacted by available revenue due to the adoption of the V28 risk model.
#medicareadvantage #healthplans #unitedhealthcare #riskadjustment #margins #optum
(Article requires a subscription.)
https://www.modernhealthcare.com/finance/optum-health-cms-v28-medicare-advantage
Conservative Groups Want Site Neutral Cuts
More than 30 conservative groups are urging Congress to use the budget reconciliation bill to impose site-neutral policies in Medicare. They argue the current policy incentivizes healthcare monopolies and site-neutral payments could save up to $150 billion. I would note it would save big in the commercial world too, as those rates are based largely on Medicare.
(Article may require a subscription.)
#siteneutral #medicare #hospitals
https://insidehealthpolicy.com/daily-news/conservative-groups-tell-congress-look-site-neutral
States Cannot Track Minimum MLR in Medicaid
An audit from the Health and Human Services (HHS) Office of Inspector General (OIG) says the Centers for Medicare and Medicaid Services (CMS) cannot track whether states are repaying the federal government the correct share of funds that Medicaid managed care plans fail to spend on beneficiary care under the minimum medical loss ratio (MLR) requirements.
#mlr #medicaid #managedcare #healthplans #medicaid #cms #hhsoig
https://www.beckerspayer.com/payer/oig-cms-isnt-tracking-some-medicaid-managed-care-payments
Huge Impact If Enhanced Premiums Not Extended
A Health Affairs Forefront blog discussed the major impact of not extending the Exchange premium enhanced subsidies due to expire at the end of this year. There would be steep premium hikes for almost all enrollees. Middle-income earners would especially be impacted as would those who are older and awaiting Medicare eligibility. There would be a major erosion of coverage.
(Article may require a subscription.)
#aca #exchanges #coverage
— Marc S. Ryan
