More on Mehmet Oz’s Healthcare Positions
President-elect Donald Trump’s nominee for the Centers for Medicare and Medicaid Services administrator, Mehmet Oz, has raised concerns with high insulin prices and the role of pharmacy benefit managers (PBMs). At the same time, he has not taken a position on Medicare drug price negotiations. He favors permanent telehealth expansions and has invested in numerous digital health companies over the years. This means he may support artificial intelligence, remote monitoring, wearables, and digital therapeutics.
Oz has long been a supporter of Medicare Advantage (MA) and even pushed for the concept of Medicare Advantage for All, which would have eliminated employer coverage and put everyone in private plans outside of Medicaid.
Additional articles: https://insidehealthpolicy.com/daily-news/oz-raised-concerns-pbms-insulin-costs-his-ira-views-unclear and https://insidehealthpolicy.com/daily-news/oz-would-bring-support-permanent-telehealth-ai-wearables-dtx-cms and https://thehill.com/policy/healthcare/5000821-trump-oz-cms-medicare-medicaid/
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#oz #cms #trump #medicareadvantage
https://www.beckerspayer.com/payer/dr-oz-on-medicare-advantage-5-things-to-know.html
PBMs Sue Over FTC Litigation Process
The country’s largest pharmacy benefit managers (PBMs) and group purchasing organizations are arguing that the Federal Trade Commission (FTC) administrative process subverts the U.S. Constitution by reforming an industry by “regulatory fiat.” This is an effort to stop the administrative actions against the PBMs. While I do support reform of the PBMs, the PBMs are not wrong here. Such cases should be tried in federal court not through administrative actions.
In addition, a New York state law and regulation will require PBMs to publish their lists of covered drugs and directories of pharmacies in their networks. They will also be barred from steering patients to their affiliated pharmacies.
Additional articles: https://www.modernhealthcare.com/legal/optumrx-cvs-caremark-express-scripts-ftc-insulin-costs-lawsuit and https://www.modernhealthcare.com/policy/new-york-pharmacy-benefit-managers-pbm-rules-cvs-unitedhealth-cigna
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#pbms #drugpricing #ftc #antitrust
Cassidy Will Have Aggressive Agenda for HELP Committee
Sen. Bill Cassidy, R-LA, who will take the helm of the Senate HELP committee, wants to see pharmacy benefit manager (PBM) reform, drug patent reform, and site-neutral policies.
Separately, the GOP seeks to radically reduce the National Institutes for Health.
Additional article: https://insidehealthpolicy.com/daily-news/republicans-including-trump-appointees-seeking-major-nih-changes
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#congress #pbms #patents #siteneutral
AI Big Focus For Hospitals And Health Plans
A new study finds more than half of health systems and health plan executives say AI is an immediate priority. About 73% are increasing their investments in the technology.
In other news, the Paragon Health Institute has published a report that could serve as a roadmap for healthcare AI policy for the incoming Trump administration.
Additional article: https://www.fiercehealthcare.com/regulatory/exclusive-paragon-health-institute-could-shape-ai-policy-under-trump
#ai #trump #healthcare
PA Remains Contentious Between Providers and Insurers
Interesting article on the ongoing contention between insurers and providers on the recent prior authorization (PA) changes. Some providers complain that the reforms have not been enough. Insurers like electronic PA but complain that the new rules hurt their ability to stop unnecessary procedures. More PA restrictions are expected from Congress and via regulation.
(Article may require a subscription.)
#priorauthorization #providers #healthplans #medicareadvantage
https://www.modernhealthcare.com/policy/prior-authorization-joe-biden-administration-cms
Wakely Predicts Possible Changes Under Trump
A good Wakely white paper on possible changes under a Trump administration. The white paper covers the expiring Exchange enhanced premium subsidies, changes to covered benefits in the Affordable Care Act (ACA), Trump’s Individual Coverage Health Reimbursement Accounts (ICHRAs), changes in the ACA Medicaid expansion, and employer coverage tax deductibility. See my view on what may happen under Trump here: https://www.healthcarelabyrinth.com/what-will-happen-in-healthcare-with-gop-firmly-in-control/ .
#election2024 #healthcare #trump
— Marc S. Ryan
