Biden Leaving His Mark On Medicare Advantage
A very good article from Bridget Early in Modern Healthcare on the history of Medicare Advantage (MA) and how the Biden administration is leaving its mark on the program. I do take issue with the continual citing of what I think is a terribly biased overpayment figure (in this article $83 billion and I have seen even more ridiculous figures). But she has an extremely balanced approach and quotes both sides of the debate (some of the most qualified you can find) and reasonably speaks to the potential damage in the form of benefit reductions and geographic contraction that is occurring due to certain policies. It gives you a good feel for MA’s history and what is going on today.
The article does a good job at inventorying changes, including health equity, risk adjustment changes, supplemental benefit changes, marketing reform, and prior authorization restrictions. As you know, I do support some reforms in MA but feel CMS has been misguided recently on some changes they made to MA, which led to the benefit reductions and geographic contraction.
The article raises an interesting point on the careful balancing act regarding oversight of the industry. Despite some of my recent misgivings about regulatory policies, I have always and still do give credit to the Centers for Medicare and Medicaid Services (CMS) on being a good regulator, moving healthcare policy forward in a reasonable and accountable fashion.
(Article may require a subscription.)
#cms #medicareadvantage
https://www.modernhealthcare.com/politics-policy/joe-biden-medicare-advantage-cms-meena-seshamani
Drug Negotiation Fallout
A new survey says more than 90% of independent pharmacies may not sell Medicare Part D prescription drugs selected to undergo price negotiation because CMS has not guaranteed fair reimbursement when the prices go into effect. The survey raises a much broader issue and is not confined to the ten drugs with negotiated prices. Independent pharmacies are upside down on many brand drugs, whether with rebates or not in the future. This is a result of both brand drug makers and pharmacy benefits managers (PBMs).
In other news, the Centers for Medicare and Medicaid Services (CMS) is being criticized for not having greater transparency and input during the first round of negotiations for the first ten drugs subject to price-setting. An expert says greater collaboration could have led to deeper price reductions. Studies show that the reductions are small compared to pricing in other developed nations. The point is a fair one, although part of the first round was a reasonable go-slow approach on the part of the administration.
Additional article: https://insidehealthpolicy.com/daily-news/experts-lack-transparency-drug-price-talks-weakened-cms-leverage-left-generics-guessing
(Articles may require a subscription.)
#drugpricing #ira #branddrugmakers
KHN Article Reviews Each Potential Administration’s Healthcare and Medical Debt Stances
Kaiser Health News (KHN) has a good article speaking to Trump’s and Harris’ views on coverage and the impact it would have on medical debt. I agree that medical debt is a huge issue in the country and expansive coverage and barring credit agencies from including it on credit reports are reasonable reforms. Harris appears to be in line with this approach, while Trump does not. As I say, healthcare could be a swing issue in the election.
In other news, Harris and Trump likely would both focus on promoting innovation and safety in terms of artificial intelligence regulation.
Additional article: https://www.fiercehealthcare.com/regulatory/how-would-trump-and-harris-handle-ai-regulation-future-president
#healthcarereform #coverage #medicaldebt #election2024 #harris #trump #ai
https://kffhealthnews.org/news/article/kamala-harris-medical-debt-cfpb-medicare/
U.S. News Announces Best Medicare Advantage and Part D Plans
U.S. News & World Report has released its list of the best Medicare Advantage (MA) and Part D insurers. Criteria and ratings are quite different than the Star Ratings from the Centers for Medicare and Medicaid Services (CMS).
#medicareadvantage #partd #pdp
https://www.fiercehealthcare.com/payers/us-news-unveils-annual-medicare-advantage-part-d-ratings
PBM Report Is Retort Of FTC Document
The three big pharmacy benefit managers (PBMs) have funded a study to counter the Federal Trade Commission (FTC) study and lawsuit against them. The FTC says anti-competitive PBM practices inflate prices and undermine pharmacies, especially independent ones. The study from the PBMs makes various arguments that PBMs save the healthcare system.
(Article may require a subscription.)
#pbms #drugpricing #antitrust
https://insidehealthpolicy.com/daily-news/pbms-float-their-own-report-bid-debunk-ftc-s-findings
— Marc S. Ryan
