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March 19, 2024

Elevance Health To Buy Kroger Specialty Pharmacy In an effort to further build out its Carelon service subsidiary, Elevance Health is buying Kroger Specialty Pharmacy.  This will add to its growing PBM offerings. Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-acquire-kroger-specialty-pharmacy and https://www.modernhealthcare.com/finance/elevance-health-carelonrx-kroger-specialty-pharmacy (Some articles may require a subscription.) #kroger #elevancehealth Link to Article ERISA Update RFI Means Battle Lines Drawn A House committee issued a request for information to see how the employer self insurance laws (ERISA) should be updated after 50 years.  Providers of course are asking for major regulation, while employers want to ensure pre-emption of state laws. Abandoning pre-emption would add demonstrably to costs.  ERISA provides the most coverage in America and it should not be played with. #erisa #coverage #employers #providers Link to Article PBM Reform Dead For Now No deal could be reached on pharmacy benefit manager (PBM) reforms despite bipartisan support in each house of Congress.  Reforms will

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March 18, 2024

Progress And Support During Change Healthcare Cyber Attack Some services have been restored by Change Healthcare and more are readying.  Change says that claim preparation software for providers will soon come back online. Electronic payments have come back online. United says it has made more than $2 billion in advanced payments from its program. United as an insurer, Highmark, and the Blue Cross and Blue Shield Association have developed advanced payment programs for providers, but many other insurers are moving slowly on the idea. Other insurers are contracting with Change competitors to help providers file claims. They also are extending claim deadlines. Provider groups say aid is not enough. The Centers for Medicare and Medicaid Services is also asking states to submit state plan amendments so they can advance Medicaid payments. Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-update-unitedhealth-systems-progress and https://www.modernhealthcare.com/insurance/change-outage-prior-authorization-pay and https://www.modernhealthcare.com/government/change-update-cms-medicaid-reimbursements and https://www.healthcaredive.com/news/change-healthcare-cyberattack-medicaid-flexibilities-american-hospital-association-survey/710561/ (Some articles may require a subscription.) #changehealthcare #cyberattacks Link

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March 15, 2024

Medicare Households Spend The Most On Healthcare Costs Good article from Fierce Healthcare and analysis from Kaiser Family Foundation on healthcare spending in Medicare households. Medicare households spend more on healthcare than other households. Health spending burden was twice as high. Analysis by KFF: https://www.kff.org/medicare/issue-brief/medicare-households-spend-more-on-health-care-than-other-households/ #coverage #costs #medicare #medicareadvantage Link to Article AHA Survey Says 94% Of Hospitals Impacted By Change Cyber Attack While for-profit hospitals are going out of their way to send a message of stability after the Change Healthcare cyber attack, an American Hospital Association (AHA) says 94% of hospitals were impacted. Mounting evidence from providers (impacted by up to $1 billion a day in revenue) and health plans (claims dried up!) that this will have big and lingering impacts. While some systems are back online, the sheer magnitude of the missed throughput of transactions is amazing and will take time to work through the backlog and

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