May 7, 2024

Telehealth and Hospital At Home Extensions Coming

The House Ways and Means Committee may pass a 2-year extension of telehealth as well as a 5-year extension of hospital at home. It would be paid for by some more moderate pharmacy benefits manager (PBM) reforms, including PBM transparency reporting and income based on service fees only.

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/wm-uses-patchwork-pbm-reforms-pay-telehealth-extenders-bill

(Some articles may require a subscription.)

#pbms #hospitalathome #telehealth #medicare


Oscar Reports First Quarterly Profit And Low MLR

Former Aetna CEO and new Oscar CEO Mark Bertolini has shaken up the financial performance of Oscar Health.  For the first time, Oscar has reported a quarterly profit and it projects a positive margin in 2024. A 42% increase in its Exchange enrollment was reported.  It will exit an alliance with Cigna concerning small group plans. It reported a rough 74% Q1 medical loss ratio and expects to come in right around the required minimum of 80% for the year.

Additional article: https://www.modernhealthcare.com/finance/oscar-health-profit-mark-bertolini



Good Summary Of Decision Dismissing Drug Makers Lawsuit On Medicare Drug Price Negotiations

Great Health Affairs Forefront Blog on the recent decision by a New Jersey federal judge to grant a summary judgment to the Department of Justice (DOJ) in the cases brought by BMS and Janssen Pharmaceuticals against Medicare drug price negotiations. The judge rejected all the constitutional, statutory, and regulatory challenges by brand drug makers.

(Article may require a subscription.)

#ira #drugpricing #branddrugmakers


Report Shows Rural Medicare Enrollees In FFS Pay More Than MA Enrollees

A great report sponsored by the Better Medicare Alliance (BMA) shows that rural enrollees in Medicare fee-for-service (FFS) pay more than those enrolled in Medicare Advantage (MA). FFS enrollees spend 49 percent more on health care premiums and out-of-pocket costs than MA enrollees. Utilization of some key services is also higher for those in MA. Due to the growth in rural areas, more than 40% of beneficiaries in these areas are now in MA.

#medicare #medicareadvantage


— Marc S. Ryan

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