November 30, 2023

Walgreen’s Launches Drug Tool

Similar to others, Walgreen’s has launched a drug price transparency and saver tool for its customers. No monthly fee applies.

#drugpricing #walgreens

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Investors Look To Medicaid Managed Care

Interesting article on investors now looking to Medicaid managed care as the Medicare Advantage market cools and is dominated by big players. While Medicaid margins are skinnier, Medicaid has been growing and states have been pushing more and more lives into managed care. Rolls will drop with redeterminations coming out of COVID, but aging and long-term care remains a big opportunity for plans and investors. (Article may require subscription.)

#medicaid #managedcare

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United Details 2024 Outlook

Healthcare behemoth United Healthcare detailed its outlook for 2024. Trends it sees will likely match the industry. United sees slower growth in Medicare Advantage, continued efforts to employ physicians, and increased investments in technology. Additional article here: https://www.healthcaredive.com/news/unitedhealth-2024-pressure-medicare-advantage-rate-change/700945/ (Some articles may require subscription.)

#medicareadvantage #united #managedcare

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FTC Lawsuit Serves Notice to Private Equity Firms Acquiring Physician Groups

Interesting article on the Federal Trade Commission’s (FTC) lawsuit against a prominent anesthesia group and its private equity owner for unfair and uncompetitive practices. Under the Biden administration, the FTC and other agencies have been active in monitoring and stopping provider acquisitions and mergers, especially with hospital consolidation. Hospital systems today own about half of all doctors. Combined, hospitals and private equity firms own about 70%. (Article may require subscription.)

#acquisitions #ftc #providers #privateequityfirms

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North Carolina Ready To Expand Medicaid

Almost a decade after the Affordable Care Act (ACA) went live, North Carolina is ready to expand Medicaid to its citizens. More than 600,000 North Carolinians are ultimately expected to qualify. It was passed by a Democratic Governor and Republican legislature. Additional article: https://apnews.com/article/north-carolina-medicaid-expansion-health-care-5c97a73a2d09b77ee9e499928590674a (Some articles may require subscription.)

#nc #medicaid #aca #obamacare

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Lawmakers Hold AI Hearing and Sound Alarm

At a Capitol Hill hearing, Republicans and Democrats alike are sounding alarm over allegations that health plans are using AI to deny prior authorization requests and claims. This one will be a rough ride. (Article may require subscription.)

#ai #priorauthorization #claimdenials #healthplans

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Additional Information on Cigna-Humana Merger

This article covers some details around Cigna exiting the Medicare Advantage (MA) market and Humana ending its commercial line. Analysts see the gold rush for MA lives as nearing completion and the merger may be perfectly timed for the two entities. (Article may require subscription.)

#cigna #humana #medicareadvantage #commercial

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Medicaid Managed Care Enrollees Satisfied With Coverage

More than 80% of Medicaid enrollees rated their health plan favorably, despite over half of enrollees reporting a problem with their plans over the past year. This news comes from a new survey from the Kaiser Family Foundation (KFF). While the article is at the link, the issue brief is here: https://www.kff.org/medicaid/issue-brief/a-look-at-navigating-the-health-care-system-medicaid-consumer-perspectives/

#medicaid #managedcare

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Wakely Publishes Analysis of 2024 ACA Exchange Rule

For the wonks out there, here is a link to Wakely’s detailed analysis of the 2025 ACA/Exchange Notice of Benefit and Payment Parameters and other key regulations.

#aca #obamacare #exchanges

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Optum Now Has 10% of Physician Workforce

Optum Health now counts 90,000 doctors — some 10% of the physician workforce — as employees or affiliates, United company leadership announced at an investor event. The growth is phenomenal as just a few years ago insurance entities owned just a few percent of doctors. Of course, hospital systems still own about a majority of doctors, with another rough 20% owned by public equity firms.

#healthplans #hospitals #physicians #providers

Link to Article

Kaiser Health News Reviews Medicare Advantage Plan-Provider Friction

I like Kaiser Health News but feel this article is a bit sensationalistic. It repeats the provider party line often and does not do enough to speak to the great value and benefit of Medicare Advantage. I think Kaiser was impacted by the aggressive provider lobby here. In my view, health plans largely act responsibly in the prior authorization and claims payment world. The Centers for Medicare and Medicaid Services (CMS) has aggressive audit oversight as well. Providers tend to have it too easy in the traditional Medicare fee-for-service (FFS) system. Is there any doubt there is huge fraud, waste, and abuse there? Recoveries by the feds each year only scratch the surface of fraud and do little on the abuse and waste sides. In addition, networks and provider selection remains strong in most places.

At the same time, health plans have to read this article to understand what is in store. The provider lobby continues to gain traction and has gotten huge wins lately. Those regulatory changes they gained and the concerted effort by providers to limit MA networks could begin to impact the program’s value.

#medicareadvantage #hospitals #providers

Link to Article

Kaiser Health News Article on Aggressive Marketing in Medicare Advantage And How You Can Help

Kaiser article reviews the recent aggressive marketing tactics in the Medicare Advantage (MA) world and some of the reforms passed down. It also also notes that the Centers for Medicare and Medicaid Services (CMS) wants your help to identify bad actors.

#medicareadvantage #marketing

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Biden Efforts To Shore Up Drug Supply Chain

In an effort to address drug shortages of essential medicines, the Biden administration is taking a number of steps, including increasing investment in domestic manufacturing of essential medicines, investing $35 million in domestic production of key starting materials for sterile injectable medicines, data sharing, and establishing a supply chain resilience and shortage coordinator at the White House. (Article may require subscription.)

#drugs #supplychains

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FDA Promotes Biosimilars In Memo

Inside Health Policy reveals that the Food and Drug Administration (FDA) issued an opinion in an internal memo that exclusivity periods for the first interchangeable drug in a class cannot be extended by the manufacturer’s decision not to bring the drug to market, even in cases where the interchangeable manufacturer was sued by the maker of the reference product. Inside Health says the move overturns a Purple Book entry. It will be the basis for upcoming guidance. The move will certainly promote early entry of biosimilars. The Biden administration has taken other efforts to promote adoption and market share of lower cost biosimilars. (Article may require subscription.)

#biosimilars #drugpricing #fda

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PBMs Want To Automatically Switch To Biosimilars

The major Pharmacy Benefit Manager-lobby is telling lawmakers not to use formulary levers to promote biosimilars but simply to allow PBMs to allow brand biologics to be automatically switched to biosimilars, even if deemed non-interchangeable by the Food and Drug Adminstration. The 2025 Medicare Advantage and Part D rule proposes additional flexibility by plans to promote biosimilars. (Article may require subscription.)

#biosimilars #drugpricing

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— Marc S. Ryan

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