November 13, 2023

Startup PBMs See Growth in Price Transparency

A series of startup PBMs are seeing some success signing up health plans by riding the price transparency train. They have even set up their own trade group to differentiate themselves from traditional PBM lobbying efforts. An interesting development, but one that will take time to break the dominance of the three giants, which control about 80% of all the business. (may require subscription)

#medicareadvantage #commercial #medicaid #pbms #pricetransparency

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Health Affairs Forefront Blog on FDA Process

I am a notable critic of the FDA. I see it as a revolving door agency (FDA to brand PhRMA and back again) and dominated by pressure from the drug industry to approve drugs that are not often ready for launch. In fairness to the FDA, here is a good article on the process and challenges FDA has, including from advocates. (may require subscription)

#fda #drugapprovals

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Providers Cite Higher Regulatory Burdens

Providers are lobbying lawmakers and policymakers on regulatory burdens. Providers have had some notable victories, including on prior authorization and interoperability, in recent years due to strong lobbying at the national level. Plans need to be aware of all the providers are telling Capitol Hill, CMS, and the media. Note prior authorization is a notable mention on burdens.

#providers #priorauthorization #medicare #commercial #medicaid #cms

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Schumer Open to Johnson’s CR Funding Plan

Senate Majority Leader Chuck Schumer (D-NY) signaled he is open to House Speaker Mike Johnson’s (R-LA) “laddered” CR approach to continue funding government in two steps through early next year. This comes after the White House and some in the Senate criticized the framework. Johnson’s approach seeks to divide up continued funding to maximize House conservatives’ leverage when the CRs expire in early 2025. He wants to fund some areas more than others. He is also looking for cuts in most discretionary spending areas.

#congress #schumer #speakerjohnson #CRs #governmentshutdown

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— Marc S. Ryan

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