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December 14, 2023

Medicare Drug Reform Law Working The Centers for Medicare & Medicaid Services (CMS) says 48 prescription drugs will have lower Part B beneficiary coinsurances in the first quarter of 2024 due to price hikes by drug makers that exceeded allowable increases, with out-of-pocket costs decreasing by $1 to as much as $2,786 per average dose. Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act (IRA). It is hard to argue that the Medicare drug reforms are not working in this case.  At the same time, CMS issued a letter to plans and PBMS urging fair reimbursement to pharmacies and urging preparation for 2024 changes under Part D. CMS letter here: https://www.cms.gov/newsroom/fact-sheets/cms-letter-plans-and-pharmacy-benefit-managers . Additional article here: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/107878 . The CMS announcement and backup material here: https://www.cms.gov/newsroom/press-releases/cms-releases-revised-guidance-medicare-prescription-drug-inflation-rebate-program . Similar Health and Human Services release and info here: https://www.hhs.gov/about/news/2023/12/14/new-hhs-actions-and-research-highlight-how-president-bidens-administration-lowering-prescription-drug-costs.html . #drugpricing #ira

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December 13, 2023

CMS Actuary Releases 2022 Healthcare Statistics The CMS Actuary has released its analysis of 2022 national healthcare expenditures. I will write a blog on this in the next week. At the link is the website where the data is uploaded. Centers for Medicare and Medicaid release here: https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights . In addition, four other articles on the new data: https://www.fiercehealthcare.com/payers/back-normal-health-care-spending-growth-rates-down-pandemic-era-times and https://www.healthaffairs.org/content/forefront/ahead-print-national-health-spending-2022 and https://www.modernhealthcare.com/policy/us-health-care-spending-rose-over-4-trillion-2022 and https://insidehealthpolicy.com/daily-news/cms-2022-health-spending-report-finds-medicaid-drove-federal-spending . Healthcare spending increased 4.1% in 2022 to $4.5 trillion. In 2022, the share of the economy devoted to healthcare spending as a percentage of gross domestic product (GDP) was 17.3 percent. Healthcare’s share of GDP as well as the percentage cost increase both went down in part due to lower government spending on the pandemic from prior years. In addition, Medicaid spending due to enrollment growth was very high. (Some articles may require a subscription.) #healthcare #costs Link to Article ONC Finalizes AI And

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December 12, 2023

A Rare Occurrence For Healthcare Costs In a rare occurrence, medical service costs at hospitals increased 2% in the first three quarters of 2023. This is about the 1.9% that the economy grew. Generally, hospital costs tend to far exceed economic growth and inflation. The report is from Turquoise, a new price transparency startup.  The findings also show that costs can vary across regions/markets as well as within markets. #pricetransparency #healthcare Link to Article At The Same Time, Overall Healthcare Costs Rising Advisory firm WTW surveyed 266 insurers across 66 countries and found that 58% are bracing for “higher or significantly higher” healthcare cost increases in the three upcoming years. Global costs increased by 10.7% in 2023, up from a 7.4% increase in 2022. The average cost trend insurers expect is 9.9% next year. #healthcare #healthinsurance Link to Article Excellent Pro Publica Analysis of Waste and Abuse in Medicare Latest estimates

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December 11, 2023

Cigna-Humana Merger Off — For Now The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/ (Some articles may require a subscription.) #healthplans #mergers #acquisitions #cigna #humana Link to Article Bill Would Reform PBMs And Introduce Site-Neutral Payments in Medicare I reported on this last week, but another good article describing a large House bill that would bring some transparency to PBMs and start site-neutral policies

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December 8, 2023

New Poll On Affordable Care Act And Healthcare Issues A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll. #healthcare #healthcarereform #affordableuniversalaccess #universalaccess Link to Article House May Cancel Physician Medicare Rate Cut A bipartisan group of representatives has introduced a bill in the House that would cancel the 2024 Medicare physician pay cut finalized last month by the Biden administration. Physicians are always on a roller coaster when it comes to rates in Medicare. I think the formula has to be revisited broadly. The House committee bill would only restore 2.5% of the 3.4% cut: https://insidehealthpolicy.com/daily-news/house-ec-bill-would-erase-only-25-physician-fee-cuts-matching-senate (Some articles may require a subscription.) #providers #physicians #rates Link to Article Bipartisan Effort Looking At Healthcare Entity Ownership And Anti-Competitive Behavior Must-read article about efforts by the

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December 7, 2023

United Health Foundation Says Chronic Conditions Rising The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources. United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen.  It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities. United calls for investments in care management as well as health equity. As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management.  Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions,

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December 6, 2023

Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden. #aca #obamacare #exchanges #medicaid Link to Article Drug Donations Help The Uninsured and Low Income Great Kaiser Health News article on drug donation programs in states.  Helping to save lives and reduce healthcare costs. #drugpricing Link to Article Exchange Enrollment Doing Very Well But Not Picking Up Many Losing Medicaid Coverage Nearly 7.3 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. It runs through January 15, 2024. The numbers from the Centers for Medicare and Medicaid Services (CMS) represents activity through December 2 (Week 5)

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December 5, 2023

Is Interest In ACA Truly Fading? The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign.  The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA). But let me take a slightly contrarian view here.  As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic.  About 70% of Democrats thought so and 32% of Republicans thought so.  To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant.  In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue? KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/ #aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform Link to Article CVS Follows Other Large PBMs in Reforming Reimbursement CVS unveiled Tuesday that it will

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December 4, 2023

U.K. National Health Service Has New Drug Pricing Deal An article in The Economist discusses the United Kingdom’s new drug pricing deal.  As we know, all other developed nations negotiate and set prices globally, as Great Britain does. The Inflation Reduction Act’s Medicare drug price negotiation will slowly bring some of what other developed nations have. In fact, we have some in force now. Key points from the article: Still, the U.K. says it is getting hurt by high-cost cancer and other drugs. The U.K. and other systems work and should be fully in place in America. (Article may require a subscription.) #drugpricing #medicare #partd #uk #nhs Link to Article Good Argument For Debt and Entitlement Commission The Heritage Foundation, a conservative think tank, has a great analysis of why a debt and entitlement commission is a good idea.  It is very factual.  A few points: #medicare #medicareadvantage #debt #deficit

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December 1, 2023

Cigna-Humana Deal Could Pass Muster While federal and state regulators will look closely and potentially oppose a combination, experts seem to think that the Cigna-Humana merger could eventually go through.  As I have indicated as well, the company profiles are quite different than earlier deals that fell through. #cigna #humana #mergers #acquisitions Link to Article Our Primary Care Problem The article makes a couple key points.  It notes the vast difference between primary care and specialist compensation.  We are clearly over-specialized in the United States.  It also discusses an important bill sponsored by Sen. Bernie Sanders, I-VT, and Sen. Roger Marshall, R-KS, that would invest $26 billion to bolster primary care, increase training opportunities for doctors and nurses, and expand access to community health centers. We do need to invest in so many ways in primary care so we can pivot healthcare from utilization management to care management. #utilizationmanagement #caremanagement #healthplans

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