Biden Administration Announced Q3 Drug Inflation Rebates
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced that many Medicare enrollees will pay less for 54 drugs available through Medicare Part B. The drugs will have a lower Part B coinsurance rate from October 1, 2024 – December 31, 2024 because drug makers increased prices higher than applicable inflation.
Over 822,000 people with Medicare use these drugs annually to treat conditions such as cancer, osteoporosis, and pneumonia. The inflation cap and rebate were passed as part of the Inflation Reduction Act (IRA), the same bill that has Medicare drug price negotiations. Savings on some drugs could be in the thousands.
Additional articles: https://www.hhs.gov/about/news/2024/09/30/hhs-announces-cost-savings-for-prescription-drugs-thanks-to-medicare-inflation-rebate-program.html and https://www.fiercehealthcare.com/payers/hhs-releases-cost-savings-54-prescriptions-including-cancer-drug
#ira #drugpricing #branddrugmakers
https://thehill.com/policy/healthcare/4904127-medicare-savings-rebates-inflation-reduction-act
CVS Facing Possible Activist Investor; To Layoff 2,900
Glenview Capital Management, a key hedge fund investor for CVS Health, will meet with the company’s top executives due to concerns about the company’s financial course. In addition, CVS confirmed it plans to layoff 2,900 in a cost-cutting initiative. Last, CVS is conducting a strategic review of options including a possible breakup due to its challenges in a number of areas.
Additional articles: https://www.beckershospitalreview.com/disruptors/investors-sour-on-cvs-health-layoffs-announced-4-notes.html and https://www.modernhealthcare.com/providers/cvs-health-glenview-capital-stock-price-layoffs-aetna-karen-lynch-larry-robbins
(Some articles may require a subscription.)
#cvshealth #aetna
CMS Says Medicare Advantage and Part D Premiums Stable
As I reported on Friday, the Centers for Medicare and Medicaid Services (CMS) says Medicare Advantage (MA) and standalone Part D (PDP) plans will have stable premiums. As I stated, I think CMS is putting the best spin possible on the 2025 benefits. Based on announcements from Humana, Cigna, Aetna, and Centene, BCBS Kansas City and others, we know there will be plan exits from service areas, network changes, and significant changes to benefits in some areas. At least 27 health systems have terminated MA plan contracts over disputes on rates, prior authorization, and claims denials. On the Part D PDP side, while the CMS premium stabilization program certainly helped (it will cost $5 to $10 billion over 3 years), we will also see formulary changes and higher cost-sharing. In addition, plan choice in the PDP world will continue to contract.
Additional article: https://www.beckerspayer.com/policy-updates/medicare-advantage-premiums-benefits-stable-for-25-cms-says-10-notes.html and https://www.fiercehealthcare.com/regulatory/cms-medicare-advantage-part-d-premiums-are-stable-2025
#medicareadvantage #cms #pdp #partd
https://www.healthcaredive.com/news/medicare-advantage-average-premiums-decrease-2025/728421
Newsom Tanks PBM Oversight Bill
In a surprise move, CA Governor Gavin Newsom vetoed a pharmacy benefit management (PBM) oversight bill. Given the near-unanimous votes in each house of the legislature, lawmakers could easily override.
In other news, Newsom did sign a bill to create an artificial intelligence (AI) law that requires payers using AI tools in coverage decisions to comply with new guardrails and regulate generative AI communications between providers and patients. Any coverage decisions must consider an individual’s clinical history and circumstances. He also vetoed a more sweeping AI regulation bill.
Additional article: https://insidehealthpolicy.com/daily-news/newsom-signs-health-ai-bills-affecting-payers-and-providers-vetoes-broader-ai-legislation
(Articles may require a subscription.)
#ai #healthcare
https://insidehealthpolicy.com/daily-news/california-governor-thumbs-down-pbm-reform-legislation
Kaiser Health News Speaks To MA’s Money Machine
I am not a fan of this Kaiser Health News (KHN) article. I think it is a bit distorted and sensationalistic. KHN crosses the line here. Its effort to balance the article with industry perspectives is fleeting at best.
But it does show what Medicare Advantage (MA) plans will be up against moving forward. I think KHN singles out MA lobbying spending when providers, including hospitals, spend just as much. Where is KHN’s profile of hospitals’ money machine and the influence providers and hospitals have over Congress? The stories of lobbying to get the Centers for Medicare and Medicaid Services (CMS) to forego penalties from audits, etc. will galvanize continued focus and reform on Capitol Hill, especially on risk adjustment and overpayments. The article gives CMS many blemishes and could also lead to some steps to stop the revolving door between the industry and the regulator.
#medicareadvantage #cms
CA Insurance Regulator Fines Anthem For Claims Disputes
The California Department of Managed Health Care levied an $8.5 million fine on Elevance Health’s Anthem Blue Cross and its Medicaid plan for failing to address claims payment disputes timely.
#claimsdenials #healthplans #hospitals #providers
Gallup Finds Two Thirds of Americans Think Healthcare Not Getting Enough Attention
A new Gallup survey finds that two-thirds of Americans say healthcare is not getting enough attention in the presidential election. They blame both parties.
#healthcare #election2024
https://thehill.com/policy/healthcare/4906746-health-care-poll-election
J & J Gives Up Scheme on 340B Program
Johnson & Johnson informed the Health Resources and Services Administration (HRSA) that it will now give up on its plans to charge hospitals and other participants upfront for certain drugs in the 340B program and then rebate the discount later.
Additional articles: https://www.modernhealthcare.com/insurance/johnson-and-johnson-drops-340b-rebate-hrsa and https://insidehealthpolicy.com/daily-news/jj-backs-340b-rebate-policy-evades-sanctions-and-ejection-program
(Some articles may require a subscription.)
#340b #drugpricing #hospitals #branddrugmakers
— Marc S. Ryan
