May 3, 2024

Biden Administration Rule Makes DACA Dreamers Eligible For Exchanges

Under a new rule, the Centers for Medicare & Medicaid Services (CMS) will make the Deferred Action for Childhood Arrivals (DACA) or dreamers eligible for Exchange enrollment. There are hundreds of thousands of Dreamers and the administration estimates that 100,000 will enroll.

Additional articles: https://www.fiercehealthcare.com/regulatory/daca-recipients-eligible-obamacare-under-cms-rule and https://www.modernhealthcare.com/politics-policy/biden-obamacare-access-daca-affordable-care-act-hhs-xavier-becerra

(Some articles may require a subscription.)

#exchanges #aca #obamacare


Cigna Says Employer Groups Increasing Coverage Of Weight-Loss Drugs

In its investor call, Cigna indicated that more and more employer groups are covering weight-loss drugs. The penetration has increased to about 50%. Larger employers tend to cover these high-cost drugs.

#weightlossdrugs #drugpricing #branddrugmakers


CVS Buys MA Broker Hella Health

CVS has acquired a startup Medicare Advantage (MA) broker based in New York City, Hella Health.  The move is thought to help CVS get a better handle on the quality of the upstream enrollment process, where third party marketing organizations (TPMOs) often skirt rules.  Regulators are cracking down on TPMOs as well as demanding that MA organizations have better oversight.

#cvshealth #marketing #medicareadvantage


Walgreens Launching Specialty Pharmacy Growth Initiative

Financially ailing Walgreens is launching an expanded Walgreens Specialty Pharmacy, a $24 billion initiative around specialty pharmacy. A major expansion of their existing offerings.



Overview of Interoperability and Prior Authorization Reforms

The Kaiser Family Foundation has published a good overview of the new interoperability rules as well as changes to prior authorization processes.

#kff #interoperability #healthplans #priorauthorization


Beckers Reports On Insurer Profits for Q1

Beckers has assembled the profits for several major insurers in Q1 2024.  Some had losses and others had major drops in profitability.  This is driven by some Medicare Advantage (MA) rate issues, the new prior authorization rule in MA and general increases in utilization and inflation.

#medicareadvantage #healthplans #margins


Capitol Hill Focuses On Drug Shortages

The Senate Finance Committee introduced bipartisan legislation that seeks to reduce generic drug shortages by improved contracting and purchasing practices in the drug supply chain. Medicare and Medicaid providers would have their procurement rules refined. In addition, some lawmakers believe that the Department of Defense should be involved in the production of drugs to combat shortages that impact members of the military.

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/warren-experts-say-dod-could-help-produce-drugs-shortage

(Some articles may require a subscription.)

#drugshortages #medicaid #medicare


Physicians Defend Private Equity in Healthcare

I very much disagree with this opinion piece in Beckers related to private equity (PE) in healthcare, but post this in the spirit of always sharing contrary views.  The authors argue that PE is a scapegoat for broader issues in the healthcare system.  While they mention some of the complaints about PE in healthcare, they neglect to go into a few areas very deep.  There are notable studies that indicate that PE’s role in hospitals tend to drive up costs and either hurt or do not improve quality. There also is the question of changing physician practice patterns to high-cost, hospital-based places. In addition, PE’s purchase of physician practices has also driven costs through the No Surprises Act arbitration process.

#privateequity #healthcare


Government Task Force Recommends Mammograms For Females 40 And Older

The U.S. Preventive Services Task Force updated its recommendation on mammograms.  It says that women should begin mammograms at age 40 and screen every other year for breast cancer until they are 74. This is for those at an average risk for breast cancer.

#prevention #healthcare


— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now