Big Pharma Gets Partial Win in Medicare Drug Price Negotiations Case
The brand drug industry got a partial victory in a Medicare drug price negotiation lawsuit when a federal appellate court partially reversed a Texas federal district court’s decision to dismiss the brand drug lobby’s lawsuit. The higher court said the drug lobby and another entity had standing on a Fifth Amendment claim, but not on others. The district court will now have to hold a full summary judgment briefing on the merits of the plaintiffs’ Fifth Amendment due process claim. This is the only one of numerous claims that Big Pharma has won in its quest to overturn Medicare drug price negotiations.
Additional article: https://www.reuters.com/business/healthcare-pharmaceuticals/challenge-us-drug-price-negotiation-program-revived-by-appeals-court-2024-09-20/
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#drugpricing #ira #branddrugmakers
At least Eight Payers Exiting Medicare Advantage
Becker’s Payer Issues is tracking Medicare Advantage (MA) plan exits. So far, there are eight plans on the list, including realignment from Aetna, Humana, Cigna, and Centene.
#medicareadvantage
https://www.beckerspayer.com/payer/5-payers-exiting-medicare-advantage-markets-in-2025.html
Particle Health Sues Epic Over Anti-Competitive Behavior
Health tech company Particle Health filed an antitrust lawsuit against Epic, alleging that the electronic health records (EHR) company that controls a large share of the market is putting up barriers to others participating in the payer platform market. Particle Health argues that Epic is engaged in information blocking. The blocking of the exchange of patient information from EMRs is barred under new interoperability rules. The two companies have been in a dispute over the flow of patient information between clients.
Additional article: https://www.modernhealthcare.com/digital-health/epic-particle-health-lawsuit-carequality
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#interoperability #emrs #providers #healthplans
Commonwealth Fund Issues 2024 Mirror, Mirror Report
The Commonwealth Fund has issued its periodic report comparing the U.S. healthcare system to those in other developed countries. The findings are similar to past reports, including America spends the most and yet has the worst metrics from an efficiency, quality, and value standpoint. See my blog today on the report: https://www.healthcarelabyrinth.com/commonwealth-fund-mirror-mirror-2024-a-portrait-of-the-failing-u-s-health-system-shows-how-much-of-a-healthcare-outlier-america-really-is/
#healthcare #healthcarereform
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
Readmission Penalties Dropping in Traditional Medicare
The number of hospitals penalized for FFY 2025 for Medicare readmissions has dropped for the second year in a row. Further, hospitals penalized 1% or more from a rate standpoint has dropped now for four years in a row.
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#readmissions #hospitals #medicare
https://www.modernhealthcare.com/safety-quality/hospital-readmission-penalties-cms-2025
CMS Issues Deadline To States For Resolving Enrollment Issues
With the redetermination backlog nearly done, the Centers for Medicare and Medicaid Services (CMS) has issued new deadlines for clearing up widespread enrollment problems identified. States must submit information by December 31, 2024 detailing how compliant the state is with existing enrollment requirements as well as a plan to correct any deficiencies. All non-compliant processes would need to be remediated by December 31, 2026.
Additional articles: https://insidehealthpolicy.com/daily-news/cms-states-must-comply-medicaid-eligibility-reqs-dec-31-2026 and https://www.beckerspayer.com/policy-updates/cms-states-have-2-years-to-fix-medicaid-renewal-problems.html
(Some articles may require a subscription.)
#medicaid #redeterminations #enrollment
https://www.modernhealthcare.com/policy/medicaid-enrollment-compliance-cms-2026
Gaetz Challenging Biden Administration On Part D Demonstration
Rep. Matt Gaetz, R-FL, is demanding the Biden administration release the 2025 Medicare Part D premium data that was supposed to be released in July. When the Centers for Medicare and Medicaid Services (CMS) saw standalone Part D plan bids with surging premiums, it hastily crafted a demonstration program that seeks to mitigate the hikes during the election year. I think the program is extra-legal and goes well beyond its demonstration authority. It also will cost taxpayers billions. The premium surges are a result of the Inflation reduction Act’s Part D changes. The government did not appropriate for most changes and therefore plans had no choice but to increase premiums. The House Committee on Oversight and Accountability will hold a hearing on the issue on September 26.
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#partd #pdp #medicare #medicareadvantage
Government Will Not Shut Down For Now
A government shutdown has been avoided with an agreement to have a continuing resolution (CR) to fund the government through December 20. A post-election-day showdown will now occur on permanent funding for FFY 2025. House Republicans caved to Senate Democrats. They wanted a longer CR to have a new president to set priorities. As well, the GOP voting measure will not be included.
#governmentshutdown #crs
— Marc S. Ryan
