Near Final Medicaid Redetermination Data In
The Kaiser Family Foundation (KFF) has done a great public service tracking and explaining the fallout over the reintroduction of Medicaid redeterminations. While some states will carry out remaining redeterminations into 2025, we are nearing the end of the journey.
About 25 million people were disenrolled for some period of time since redeterminations began again in April 2023. There is some good news and bad news to the near-end of this redetermination story. The pause in redeterminations during the pandemic allowed rolls to grow in Medicaid and children’s health insurance to 94 million. Even with losses, almost 10 million more people are covered now than before the pandemic. At the same time, 13 million have lost Medicaid coverage since the peak. Many but not all have gained coverage in other ways.
Kaiser Family Foundation press release: https://www.kff.org/medicaid/press-release/as-medicaid-unwinding-concludes-in-most-states-kff-finds-25-million-lost-medicaid-coverage-but-enrollment-is-10-million-higher-than-pre-pandemic-levels/
#medicareadvantage #walmart #humana #primarycare
HRSA Notifies J & J To Cease Rebate Approach in 340B
The Health Resources and Services Administration (HRSA) notified Johnson & Johnson it must stop its move to a rebate program for 340B drugs. HRSA says the rebate approach violates the 340B statute. It must return to granting a reduction upfront. The rebate program was rolled out on two drugs. I am not unsympathetic to efforts by brand drug makers to rein in the abuse of the program, but the company probably got too far beyond the law here.
Additional article: https://www.modernhealthcare.com/policy/johnson-and-johnson-340B-rebate-hrsa
(Some articles may require a subscription.)
#hospitals #340b #branddrugmakers #drugpricing
https://www.healthcaredive.com/news/hrsa-threatens-jj-340b-rebate-plan-sanctions/727339/
Health Plan Will Struggle With Mental Health Rule
The Biden administration recently finalized a new mental health rule that seeks to get mental health benefits much closer to true parity. But health plans and employer groups are very worried that compliance will be very costly, complex, and may be unfeasible. There are also doubts that the rule will be effective.
(Article may require a subscription.)
#mentalhealth #healthplans #employercoverage
California Could Regulate PBMs
California could soon have a law that regulates pharmacy benefits managers (PBMs). It would join 25 other states that have various depths of regulation. The bill would mandate license by 2027 and passing along 100% of pharmaceutical manufacturers’ rebates to health plans or insurers. The law would also restrict steering patients to pharmacies they own. It would also ensure that independent pharmacies do not receive lower insurance reimbursements than big chains. Some state laws are being challenged in court by brand drug makers, which argue preemption.
#pbms #ca #drugpricing
https://kffhealthnews.org/news/article/california-pharmacy-benefit-manager-licensing-regulation
Ozempic Likely a 2027 Medicare Drug Price Negotiation Target
Given the huge growth in costs for Medicare Part D, Novi Nordisk, maker of Ozempic, says the GLP-1 weight-loss drug will likely be one of the next drugs on the negotiation list.
(Article may require a subscription.)
#glp1s #weightlossdrugs #branddrugmakers
MA Plan To Shutter in 2025
Southwestern Health Resources will not offer Medicare Advantage (MA) plans in 2025, citing the cost pressures in the market. The company has around 26,000 MA members.
#medicareadvantage #healthplans
https://www.beckerspayer.com/payer/texas-system-shutters-medicare-advantage-plan.html
Democrats Want 2024 Extension Of Enhanced Premiums Subsidies
Citing the major disruption to insurance and care, House and Senate Democrats are pressing leadership to quickly pass legislation extending ObamaCare’s enhanced subsidies, which are set to expire at the end of 2025. Passage this year is unlikely in the GOP-controlled House. The Congressional Budget Office says permanently extending ObamaCare’s tax credits would increase the deficit by $335 billion over the next 10 years.
#exchanges #aca #obamacare #coverage
https://thehill.com/policy/healthcare/4886672-democrats-urge-extension-obamacare-subsidies
Nursing Home Staffing Bill Not Likely To Move
Senate Republicans are saying that they will not press legislation that would overturn a Biden administration nursing home staffing rule, saying it would likely pass but Biden would veto the bill. The rule was a political sop to unions to increase staffing. The rule is untenable and likely will lead to huge financial problems for smaller homes and eventual consolidation in the industry. The rule is likely to be struck in court over time for exceeding regulatory authority.
#nursinghomes #medicaid #medicare #healthcare #staffing
https://thehill.com/policy/healthcare/4884938-republicans-biden-nursing-home-rules
— Marc S. Ryan
