mergers

New Alzheimer’s Drug Spending Will Leap In Medicare The Centers for Medicare & Medicaid Services (CMS) says spending on the new Alzheimer’s drug Leqembi will leap well over estimates. CMS estimates that per member per month spending on Leqembi will rise from $1.67 in 2024 to $4.67 in 2025. This will bring spending across all Medicare to $3.5 billion in 2025. This threatens to add demonstrably to Medicare troubles and will hike Part B premiums. #drugpricing https://www.fiercehealthcare.com/regulatory/report-cms-projects-spending-leqembi-will-hit-35b-next-year Federal Appeals Court Reinstates Denial Case Against United A federal appeals court allowed a proposed class action lawsuit to continue. The case alleges that UnitedHealth Group used an algorithm to more stringently review patient claims for substance abuse treatment. Both prior authorization and medical claims denials are being closely scrutinized right now. (Article may require a subscription.) #priorauthorization #claimsdenials https://www.modernhealthcare.com/legal/unitedhealth-behavioral-health-lawsuit-substance-abuse Bipartisan Support For Medicare Doc Fix Senate Finance Chair Ron Wyden, D-OR, and

Community Health Centers Suffering From Medicaid Disenrollment A new study of patients at community health centers are reporting major Medicaid disenrollments, which impacts the level of care that can be provided to these individuals.  Community health centers largely serve those in low-income areas. It also finds that about 75% of people who have lost Medicaid coverage are still disenrolled. Further, 32% have chronic conditions, 24% are children, 12% were adults older than 65 years of age and 12% had disabilities. #medicaid redeterminations #primarycare https://www.fiercehealthcare.com/payers/one-year-after-unwinding-community-health-centers-struggle-medicaid-reenrollment Provider Impacts Continue From Cyberattack Physicians continue to see major impacts due to the Change Healthcare cyberattack. This comes from an American Medical Association (AMA) survey of more than 1,400 individuals. Over 77% of those surveyed said they experienced service disruptions beginning Feb. 21 and still feel impacts. Over a third (36%) saw claims payments suspended and 32% have not been able to submit claims. About