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Study: Hepatitis C drugs will 'strain budgets' at current prices
New hepatitis C drugs promise cure rates above 90 percent, but could prove to be budget-busters for public and private health insurers, a new analysis finds.
Recently approved drugs for chronic hepatitis C have been heralded as a breakthrough that could make the liver disease "rare" in the United States. But with prices topping $1,000 per pill, government and private insurers are balking — often putting limits on which patients qualify for coverage.
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UnitedHealth's $12.8 billion answer to expensive prescription drugs
In a deal that could help wrest back control over the soaring cost of prescription drugs, UnitedHealth Group's Optum Rx Corp. will buy pharmacy benefit manager Catamaran Corp. (CTRX) for $12.8 billion.
UnitedHealth Group (UNH), already the nation’s largest health insurance company, will become a giant among so-called PBMs, which are the middleman between drug manufacturers and employers when it comes to purchasing pharmaceuticals.
April 1 Webinar Wednesday: 'Medication Monitoring & Pharmacogenetic Testing (PGT): Helping Clinicians to Individualize Safer Opioid Management'
Opioid side effects and the effect of poly pharmacy have been highlighted recently in the media. Clearly, there are challenges to safely treating chronic pain in the midst of the national crisis of prescription drug abuse. This case-based webinar will highlight clinical and research experiences of integrating UDT & PGT to help improve care for the treatment of chronic pain and common co-morbidities such as anxiety and depression.
Senate passes GOP budget after late-night debate
The Huffington Post
The Senate passed a Republican budget plan that would cut spending by $5.1 trillion over 10 years, raise military funding and repeal Obamacare.
The non-binding budget, debated all week and passed 52-46 during a 15-hour marathon session before the Easter recess, gives Republicans another crack at repealing the Affordable Care Act, probably through a process known as reconciliation, and increases defense spending while slashing funds in other areas, including education and healthcare.
Senators reject push to restore Medicaid funding
Senators recently rejected an amendment that backed restoring more than a trillion dollars to Medicaid.
Senators voted 47-53 on the proposal, introduced by Sen. Ron Wyden (D-Ore.). Sen. Susan Collins (R-Maine) broke rank and voted with Democrats. The amendment would have rolled back more than $1.2 trillion in cuts to Medicaid.
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Bipartisan majority of Montana senators backs Medicaid expansion bill
The bill expanding Medicaid to bring government-financed health coverage to an estimated 45,000 low-income Montanans advanced recently in the state Senate, as a bipartisan majority endorsed it on a 28-22 vote.
“These are our citizens, our neighbors, our friends ... who don’t have healthcare,” said Senate Minority Leader Jon Sesso, D-Butte, who supported Senate Bill 405.
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Michigan Medicaid expansion enrollment soars; waiver hurdle remains
The Charlotte Observer
More than 600,000 low-income adults have signed up for Medicaid a year after Michigan expanded the insurance program under the federal healthcare law.
Now Gov. Rick Snyder's administration is working to ensure the Healthy Michigan program continues.
Michigan law requires the state to get a second waiver from the Obama administration by year's end or the Medicaid expansion will end next April.
Florida health officials propose Medicaid enrollment change
Florida health officials want to remove Medicaid's 30-day wait period so people can automatically enroll for health insurance once they're deemed eligible.
The proposed amendment would also get patients information more quickly about their plan options to encourage them to choose their own plan instead of being automatically enrolled in one.
Some face a big bill from Medi-Cal — after they die
Kaiser Health News
Catherine Jarett ran into a nasty surprise after she sent a form to Medi-Cal on behalf of her clients. An estate attorney, Jarett was hired by the sons of an elderly Vallejo woman who had died. For more than 20 years, the woman had been enrolled in Medi-Cal, as the state’s Medicaid insurance program for the poor is known.
New Mexico Inmates could enroll in Medicaid under bill
State lawmakers approved a bill in the final days of the session that, if signed by Gov. Susana Martinez, would help thousands of inmates enroll in Medicaid and make them eligible for services upon release, officials said.
The measure would allow inmates to apply for Medicaid coverage during their incarceration and directs the state Human Services Department to create a process to help inmates enroll. The agency currently does not accept Medicaid applications from inmates.
Many families may face sharply higher costs if public health insurance for their children is rolled back
Millions of U.S. children could lose access to public healthcare coverage if Congress does not renew federal funding for the Children’s Health Insurance Program (CHIP), which is set to expire Sept. 30, 2015 — the end of the federal fiscal year. Additional cuts in public coverage for children in families with incomes above 133 percent of the federal poverty level are possible if the Affordable Care Act’s “maintenance of effort” provisions regarding Medicaid and CHIP are allowed to expire as scheduled in 2019.
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Second-generation antipsychotic drug use among Medicaid-enrolled children: Quality-of-care concerns
Office of Inspector General
In the five States, 8 percent of SGAs were prescribed for the limited number of medically accepted pediatric indications. There are only five SGAs with medically accepted pediatric indications. It is not uncommon for doctors to prescribe, or Medicaid to pay for, SGAs for children for indications that are not medically accepted. Medically accepted indications include both uses of drugs approved by the FDA and uses supported by one or more of three drug compendia. It is difficult to conduct the clinical trials needed to obtain FDA approval or compendia support for pediatric uses of drugs.
Lessons churned: Measuring the impact of churn in health and human services programs on participants and state and local agencies
Center on Budget and Policy Priorities
Public benefit programs for low-income individuals and families typically require households to apply, establish eligibility, and then, at subsequent regular intervals, to re-establish eligibility. While periodically reviewing eligibility is important for ensuring that benefits are properly targeted to individuals and families that remain eligible for assistance, the redetermination process can result in eligible households temporarily losing eligibility, experiencing a short period without benefits, and then reapplying — a phenomenon sometimes called “churn.”
April 15 Webinar Wednesday: 'The Role of Medicaid Managed Care Organizations in State Innovation Models'
The State Innovation Model grants are being widely used to develop and test multi-payer payment and service delivery reform. These models can have a significant effect on Medicaid managed care organizations (MCOs). This webinar will explore the potential roles of Medicaid MCOs in a State Innovation Model (SIM) driven reform initiative. Please join Director Randolph Gordon and Specialist Leader Jim Hardy for Deloitte Consulting LLP who will discuss challenges related to provider contracting, care management, information technology, market positioning, and strategies for success.
Did you miss Webinar Wednesday: 'AAAHC Health Plan Accreditation with a Spotlight on Chronic Disease Management' by AAAHC?
Download the presentation here.
For copies of other past webinars, visit here.
Pay for success, social impact bonds: Request for proposals
Green & Healthy Homes Initiative
The Green & Healthy Homes Initiative released a request for proposals from asthma-related service providers to develop asthma social impact bond/pay for success projects. GHHI and its partner Calvert Foundation will provide technical assistance to five selected service providers in the catchment areas of the previously selected healthcare organizations:
Please review the RFP; proposals are due April 8.
- Baystate Health (Springfield, MA)
- Le Bonheur Children's Hospital (Memphis, TN)
- Monroe Plan for Medical Care (Buffalo/Rochester, NY)
- Spectrum Health (Grand Rapids, MI)
- University of Utah Health Plans (Salt Lake, UT)
Medicaid Managed Care Congress: May 20-22 in Baltimore
Medicaid Managed Care Congress
At the Medicaid Managed Care Congress, government officials, health plan executives and other key players of the healthcare ecosystem come together to hear new case studies from industry peers and expert insights from state and federal regulatory bodies. This event will discuss the successes and challenges of implementation of major ACA provisions, delivery reform and payment reform and states pursuing better value. Use code XP2026MHPAB for a 15-percent discount.
MHPA's Legislative Fly-In | May 11 | Washington, DC
Join us for MHPA's Legislative Fly-In, scheduled May 11 and 12 at the Liaison Capitol Hill Hotel, to educate lawmakers on our industry and its key issues.
Click here for reservation information.
For details, please contact Nikida Levy via email or by phone at 202-857-5720.
Job opportunity: Clinical director, Homecare & Managed Care
First Quality, a leading manufacturer of disposable home healthcare products, is seeking a clinical director for our Homecare & Managed Care Business. This candidate will provide leadership and have a focus on clinical education, utilization management protocols and programs and operational program development within homecare and managed care markets.
Job opportunity: Physician contract negotiator | Chicago
Negotiates, re-negotiates and executes physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals. Medicaid and Medicare contracting experience strongly preferred. Enter Requisition #22158.
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