healthcarereform

What Will Health Policy Look Like Under A Trump 47 Administration? As the Republican National Convention (RNC) begins this week, a Modern Healthcare article finds that the GOP platform is light on healthcare.  However, it points to Trump 45’s record, documents from the House Republican Study Committee, and the Heritage Foundation’s Project 2025 for possible insights into a Trump 47 healthcare agenda. Culling it all together, policy likely will be fundamentally different from the current administration.  Whether the Affordable Care Act (ACA) is repealed or not, coverage declines can be expected in the Exchanges and Medicaid.  Despite some reform proposals, Trump has distanced himself from radical changes in Medicare. It is unknown if Trump would pick up his previous stances on drug pricing, which are much closer to President Biden’s views. (Article may require a subscription.) #election2024 #healthcare #trump #biden https://www.modernhealthcare.com/politics-policy/donald-trump-republicans-2024-election-medicare-medicaid-aca-abortion-project-2025 Chevron Sunset Opens Up Many Litigation Fronts Interesting article

Price Transparency Hearing Shows More Needs To Be Done A Senate hearing on price transparency shows much more needs to be done on price transparency despite progress during the Trump and Biden years. #pricetransparency #healthcare #healthplans #hospitals https://www.fiercehealthcare.com/regulatory/it-isnt-normal-senators-condemn-insurers-hospitals-resistance-price-transparency FFS Medicare Physician Pay Cuts Proposed Despite More Money For ACOs The Centers for Medicare and Medicaid Services (CMS) is a bit schizophrenic on physician pay, proposing a base physician pay cut in Medicare but added incentives in the Accountable Care Organization (ACO) reform pilot.  There is little evidence thus far that ACOs are redefining cost and quality in the traditional Medicare program. (Article may require a subscription.) #acos #medicare #physicians https://www.modernhealthcare.com/policy/cms-aco-proposals-medicare-shared-savings-program-health-equity-value-based-care Republican Platform Light On Policy Details Former President Trump put his stamp on the Republican Party platform, but it looks light on details.  Trump has distanced himself, from the Heritage Foundations’ “Project 2025.” #election2024 #healthcare https://www.medpagetoday.com/washington-watch/electioncoverage/111080 HELP Committee Examines Medical

Senate Passes Key Generic and Biosimilar Drug Competition Measure The Senate unanimously passed a bill that would bar so-called “patent thickets” and similar measures that brand drug makers use to stop the swift entry of generics and biosimilars. Drug makers would be barred from using multiple patents and lawsuits to stop generic and biosimilar approval. As well, the companies could not essentially “re-patent” drugs by making cosmetic changes. The Federal Trade Commission (FTC) would also have power to impose limits on patent litigation on biologics. (Article may require a subscription.) #drugpricing #branddrugmakers #biosimilars #generics https://insidehealthpolicy.com/inside-drug-pricing-daily-news/advocates-applaud-senate-passage-patent-thicket-reform-bill Could Smaller, Innovative PBMs Thrive At Expense of Big 3 Not too many years ago, the Big 3 pharmacy benefits managers (PBMs) dominated the business because their size and scope delivered the most cost-savings.  But the rise of transparency and headlines about how traditional PBMs could be abusing employers and insurers has smaller PBMs, including

FTC To Sue Big Three PBMs The Wall Street Journal (WSJ) is reporting that the Federal Trade Commission (FTC) will sue the Big 3 pharmacy benefits managers (PBMs) – United’s Optum, Cigna’s Express Scripts, and CVS’ Caremark — over anti-competitive behavior.  The suits could center on the vertical integration with their sister health plans, which means the PBMs favor corporate-owned pharmacy assets at higher costs to the public. The suit may also challenge rebate deals with brand drug makers and concomitant formulary restrictions. The move likely means more pushes on Capitol Hill to reform PBMs. While some of this may be true, I continue to believe that brand drug makers are the biggest problem in terms of high drug prices. Additional article: https://www.fiercehealthcare.com/payers/wsj-ftc-sue-pbms-over-drug-pricing-tactics #pbms #drugpricing #ftc #antitrust https://www.healthcaredive.com/news/ftc-to-sue-pharmacy-benefit-managers-caremark-express-scripts-optumrx-wsj/72102 Brand New Interoperability Rule Published Even though major new interoperability requirements have yet to go into effect, the nation’s healthcare interoperability regulator,

New FTC Investigation Report Targets PBMs In its initial report on an antitrust investigation into the role of pharmacy benefits managers (PBMs), the competitiveness watchdog Federal Trade Commission (FTC) says PBMs have vast power that disadvantages consumers and independent pharmacies. It reports the following: The major PBM lobbying group pushed back on the findings vigorously.  While PBMs need reform and more transparent approaches, I feel the FTC has put the entire onus for high prices and anti-competitive behavior on PBMs and not brand drug makers. The FTC has adopted the same whipping boy mentality as Congress. Additional articles: https://www.fiercehealthcare.com/payers/ftc-report-pbms-may-urgently-require-potential-regulation and https://www.modernhealthcare.com/politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth and https://thehill.com/policy/healthcare/4762024-federal-trade-commission-report-pharmacy-middlemen-price-hikes/ (Some articles may require a subscription.) #pbms #drugpricing https://www.healthcaredive.com/news/ftc-pharmacy-benefit-manager-investigation-interim-report/720814 Physician Burnout Declining The portion of physicians who report at least one symptom of burnout has dropped below 50%, the first-time since the beginning of the COVID-19 pandemic. #covid #providers #physicians https://www.fiercehealthcare.com/providers/physician-burnout-drops-below-50-first-time-2020-ama-poll-finds Sackler Family May Be Sued By