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January 9, 2024

NY Wins Medicaid Waiver Approval New York received an 1115 Medicaid waiver approval from the Centers for Medicare and Medicaid Services (CMS) covering a myriad of innovations, including recruitment and retention of Medicaid providers, eligibility to bill social needs spending, primary care investments, behavioral health investments, and health equity pilots. CMS press release here: https://www.cms.gov/newsroom/press-releases/cms-approves-new-yorks-groundbreaking-section-1115-demonstration-amendment-improve-primary-care #medicaid #cms #waivers #socialneeds #healthequity Link to Article Both Cigna And CVS Say They Are Ready For Changes in PBM World Both Cigna and CVS, owners of two of the three largest traditional Pharmacy Benefits Managers (PBMs) say they are ready for the transformation in the world of PBMS that may be coming. Cigna went as far as to say they welcome unbundling, where plans may hire multiple entities to service them in a transparent way. See my Blog on PBM Transparency from December 14 for the emerging changes in the PBM industry: https://www.healthcarelabyrinth.com/pbm-transparency-and-reform-is-a-big-trend-in-the-american-healthcare-system/ #pbms

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January 8, 2024

Aetna Turnaround On Stars And Enrollment Is Amazing At the JP Morgan conference, CVS President and CEO Karen Lynch was taking a well-deserved victory lap.  With all that is going on at CVS, the Aetna turnaround on enrollment and Stars in Medicare Advantage (MA) is amazing.  It is no small feat given competitiveness in the MA world and the major changes in Star for 2024.  #cvsaetna #cvshealth #aetna #medicareadvantage Link to Article Clover Touting Clover Assistant Clover Health also deserves credit for its work creating the Clover Assistant.  It has been shown to promote better outcomes, especially in the tough pharmacy adherence area. With prior authorization to take a back seat, data analytics and member and provider engagement are key to reducing and controlling medical expense at health plans. #clover #dataanalytics #engagement #caremanagement Link to Article Alignment Healthcare Bullish On Membership And Positive Margin Alignment Healthcare John Kao expects major

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January 5, 2024

FDA Approves Florida Drug Importation The Food and Drug Administration (FDA) has approved Florida to import prescription drugs from Canada via bulk purchasing.  This would mean Florida residents would have access to Canadian wholesale prices, which are far lower than in the United States.  Brand drug makers immediately attacked the waiver as reckless and claimed it could endanger health.  Nonsense.  Canada is a developed country with a great safety record. The waiver also has strict quality control measures in it. This is yet another stunt by Big Pharma to maintain its high prices in the United States. It likely will sue to stop it. Canada, too, could disrupt the plan if it results in shortages there.  Although the targeted drugs right now look like they are in reasonable supply, look out for a “manufactured” crisis to emerge. This is a feather in the cap of presidential candidate and Fl. Gov.

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January 4, 2024

Hospitals, Payers Have Better Compliance With Transparency Requirements Hospitals and payers seem to be complying more with required price transparency postings.  As well, the Centers for Medicare and Medicaid Services (CMS) has ramped up enforcement.  New rules went into effect 1/1 and Congress wants to codify the rules and enhance them. Additional article here: https://www.medpagetoday.com/special-reports/features/108126 #transparency #pricetransparency #healthplans #hospitals #cms Link to Article Physician and Hospital Groups Object To Info-Blocking Penalties In Proposed Interoperability Rule Provider and hospital groups dislike proposed penalties for info-blocking under a new proposed interoperability rule.  Penalties include a change in meaningful-use status in federal programs and reductions in payments. Additional article here: https://insidehealthpolicy.com/daily-news/stakeholders-seek-less-severe-penalties-potential-info-blocking-claims (Some articles may require a subscription.) #interoperability #infoblocking #hospitals #providers Link to Article Lawmakers Miss Medicare Advantage’s Benefits Lawmakers at a symposium on Medicare drug pricing complained that healthcare inflation is impacting Medicare provider payments and hurting access for Medicare beneficiaries. They

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January 3, 2024

Aggressive Agenda for Healthcare on Capitol Hill Good article on all the healthcare priorities for 2024.  This tracks very closely to my predictions for 2024 blog ( https://www.healthcarelabyrinth.com/channeling-nostradamus-the-healthcare-labyrinths-2024-predictions/ ). As I noted, a continuing resolution (CR) or other funding bill must pass soon to keep healthcare agencies open. As well, the article says that price transparency reporting, PBM reforms, and site-neutral payments are on the agenda. Note the reference to the long shot possibility of Medicare Advantage (MA) payment reductions. Troubled by prior authorization and overpayment headlines, Congress could take a bite out of rates for MA plans. This was also a possibility I raised in my predictions. There is also the issue of physician fee cuts in Medicare. (Article may require a subscription.) #transparency #pricetransparency #governmentshutdown # crs #siteneutral #pbms #medicareadvantage #medicare #overpayments #providers #rates Link to Article FDA Approvals Up FDA approvals of new novel drugs are up. 

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