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July 16, 2024

Despite Conservatism, Vance Has Surprising Record On Healthcare J.D. Vance is seen as a rightist Republican. But Donald Trump may have chosen a bit of a maverick on healthcare for his VP partner. In the past, Vance has criticized the Obamacare repeal because it would have impacted lower income people. In addition, he has signaled support on drug price reform, which is similar to Trump’s position. While he previously endorsed Medicare cuts, he has backed away from this position and has indicated that more should be spent on healthcare. Additional article: https://insidehealthpolicy.com/daily-news/jd-vance-s-record-includes-drug-negotiation-support-mixed-record-medicare-abortion (Some articles may require a subscription.) #election2024 #trump #vance https://thehill.com/policy/healthcare/4775098-vance-healthcare-positions UnitedHealth Reports Q2 Earnings UnitedHealth Group reported that second-quarter net earnings declined 23% year-over-year to $4.2 billion. It reported revenue of $98.9 billion, a 6.5% increase from the prior year period. The medical loss ratio (MLR) was 85.1%, an increase from 83.2% a year ago. High Medicaid and Medicare

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July 15, 2024

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  Whether the Affordable Care Act (ACA) is repealed or not, coverage declines can be expected in the Exchanges and Medicaid.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

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July 12, 2024

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

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July 11, 2024

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

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July 10, 2024

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,

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July 9, 2024

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

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July 8, 2024

New Wall Street Journal Study To Generate Huge Capitol Hill Focus A Wall Street Journal (WSJ) analysis published today finds that Medicare Advantage (MA) plans filed numerous questionable diagnoses in the risk adjustment program to generate about $50 billion between 2018 and 2021. The WSJ found diagnoses for patients that did not have certain conditions or could not possibly have such conditions. It also found that many conditions were diagnosed at a much higher rate in MA than in the traditional fee-for-service (FFS) prorgam. This adds to numerous other private and public studies that will be fodder for reforms coming from Capitol Hill on MA overpayments. As many of you know, I am a defender of MA and feel that some accusations of overpayments are not accurate.  I do not doubt there are some inaccuracies in what the WSJ found as well.  At the same time, I have said there

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July 5, 2024

Brand Pharma Spends More On Stock Buybacks And Marketing Than R&D A report from Accountable, a nonpartisan watchdog group, found that brand drug makers spent more on stock buybacks, marketing, and other related spending than on research and development (R&D). Accountable said the companies spent $95.9 billion on R&D expenditures in 2023, but spent 70% more on stock buybacks, dividends, and marketing and administrative costs. It also found that the companies spent nearly $500 million collectively on executive and board compensation, at least $83.2 million on trade association dues, $10.6 million on political contributions and $57.8 million on lobbying. This is consistent with a report from Sen. Bernie Sanders, I-VT, and Democrats on the Senate HELP Committee. Accountable argues that these are areas that spending could be reduced to offset any potential impact on margins and a commensurate reduction in R&D due to Medicare drug price negotiations. As they always

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July 3, 2024

CMS Published Recalculated 2024 Medicare Advantage Star Scores The Centers for Medicare and Medicaid Services (CMS) made public its revised Star scores for 2024 for Medicare Advantage (MA) plans today. The agency will have to fund an additional $1.3 billion after being rebuked by two courts on how it ignored regulations when setting guardrails for 2024. Actuarial firm Milliman says seventy-six MA contracts from 44 insurers (with almost 3.5 million members) saw increased Star scores. (Article may require a subscription.) #medicareadvantage #stars #cms https://www.modernhealthcare.com/medicare/medicare-advantage-star-ratings-recalculation-scan-elevance Application Backlogs And Lagging Redeterminations In Medicaid Healthcare policy advocates are reporting that more states might be falling behind in processing Medicaid applications due to all going on with redeterminations.  The Centers for Medicare and Medicaid Services (CMS) recently said nine states and the District of Columbia will go past the June 2024 deadline for processing redeterminations. (Article may require a subscription.) #medicaid #coverage #redeterminations https://insidehealthpolicy.com/daily-news/latest-unwinding-data-show-states-falling-behind-medicaid-application-processing

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July 2, 2024

KFF Analysis Says MA Still Has Highest Margins A Kaiser Family Foundation (KFF) analysis says that the highest gross margins were found in Medicare Advantage (MA) in 2023. At the end of 2023, gross margins per enrollee in MA were $1,982 on average compared to $1,048 in the individual market. Medicaid was the lowest at $753. Group plans fell in the middle at $910. Despite some of the troubles health plan are having with MA right now, the data proves MA is still a good place to be, with high revenues per enrollee and the ability to reduce spending to generate good margins. KFF Analysis: https://www.kff.org/medicare/issue-brief/health-insurer-financial-performance/ #medicareadvantage #healthplans https://www.fiercehealthcare.com/payers/kff-insurance-market-had-highest-gross-margins-last-year Five States Extend Medicaid To Incarcerated Individuals Residents in Illinois, Kentucky, Oregon, Utah and Vermont will receive Medicaid or children’s health insurance coverage prior to release to minimize gaps in insurance coverage. #medicaid #chip #managedcare #coverage #healthcare #healthcarereform https://www.fiercehealthcare.com/payers/hhs-approves-incarceration-transition-coverage-five-states Biden And

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