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Gilead's hepatitis C drug, Sovaldi, on pace to
become a blockbuster

The New York Times
Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, a huge figure that puts it on track to become one of the world's best-selling medicines but could intensify concerns about society's ability to pay for it. The sales, announced by Gilead Sciences, were an increase from the $2.3 billion in the first three months of the year, the first full quarter of sales since the drug's approval in December.
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mhpa2014 annual conference session on specialty drug pricing
MHPA
With Gilead's record-breaking, second-quarter earnings and its all-oral treatment for hepatitis C due out in October, you won't want to miss Express-Scripts Senior Vice President and Chief Medical Officer Dr. Steven Miller for his discussion, "A Cure Isn't a Cure if You Can't Afford It: Why Drug Pricing Matters."

Sign up before Sept. 8 to save on registration for mhpa2014. For more annual conference details, please click here.

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New England Journal of Medicine report: 10 million newly insured
Politico
The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans — this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage — although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation.
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New Democratic caucus will pressure GOP governors to expand Medicaid
The Washington Times
VideoBriefNearly three dozen Democrats have forged a congressional caucus to call on Republican-led states to expand Medicaid under President Barack Obama's healthcare law. Tennessee Rep. Steve Cohen, a Democrat, unveiled the 34-member group by calling on his home state to augment the health program for the poor, as 27 other states have done.
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Reform update: Many dual-eligibles opt out of care coordination
Modern Healthcare (Subscription required)
People who are eligible for both Medicare and Medicaid are opting out at high rates from voluntary state initiatives aimed at better coordinating their care. So-called dual eligibles often have a difficult time navigating the policies of both programs to get the services they need.
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CDC: Many children with Medicaid use ER as doctor's office
HealthDay via The Philadelphia Inquirer
Children covered by Medicaid visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And children with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention.
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Burwell appoints new counselor from Wal-Mart
The Hill
Health and Human Services Secretary Sylvia Burwell continued her management shake-up by naming a former vice president at Wal-Mart as senior adviser. The move to bring Leslie Dach to HHS reveals Burwell's interest in heading off problems during Obamacare's second enrollment period, due to start in November. The new HHS secretary also wants to add professionals with significant private sector experience to her inner circle.
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Paul Ryan to unveil antipoverty plan; doesn't include Medicaid
The Washington Post
VideoBriefHouse Budget Committee Chairman Paul Ryan will shift from his years-long focus on cutting federal spending to an antipoverty proposal that seeks to overhaul the safety net but also leaves in place existing levels of funding. The proposal is part of an effort to reorient the Republican Party away from battles of recent years and toward addressing the economic anxieties of the most disadvantaged Americans.
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MHPA Board of Directors meeting on July 28 in Washington, DC
MHPA
Attention all MHPA board members: Please join MHPA Board Chairman Frank Siano and MHPA staff at our meeting on Monday, July 28, at the Doubletree by Hilton Hotel in Washington, D.C., to discuss issues in Medicaid managed care affecting our association and our industry. The meeting will run from 9:30 a.m. to 4 p.m. Cocktail reception to follow.
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Groups sue Tennessee over Medicaid enrollment delays
Kaiser Health News
Three consumer advocacy groups filed a class-action lawsuit accusing Tennessee officials of adopting policies that are depriving thousands of people of Medicaid coverage "to score political points." The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid.
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Medicaid enrollees strain Oregon
The Associated Press via The Washington Post
Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal healthcare overhaul and created a new system to improve the care they received. A review, however, shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid.
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Senators question cost of $1,000 hepatitis drug
The Hill
Two high-ranking senators have lent their voices to the chorus demanding to know why Gilead's new hepatitis C drug Sovaldi costs $1,000 a pill. Oregon Sen. Ron Wyden, chairman of the Senate Finance Committee, and Iowa Sen. Chuck Grassley, the Judiciary Committee's ranking member, are asking the specialty drugmaker how they justify the high price of the medication, which can cost more than $84,000 per treatment.

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HHS offers states $100 million to improve Medicaid
The Hill
The Department of Health and Human Services is offering $100 million to state Medicaid programs to reform payment systems and improve patient care. Governors and state Medicaid directors had pressed the Centers for Medicare and Medicaid Services for funds to review and improve the health program.

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How do you pay for a drug that costs $84,000?
The Washington Post
There's a new $84,000 treatment for hepatitis C that's giving new hope to patients. But it's also giving a healthcare system strained by limited resources a strong reality check. Since Gilead Sciences unveiled Sovaldi more than six months ago, its $84,000 price tag has ignited a conversation in the health policy world about how to make lifesaving medicines more affordable without hurting drugmakers' incentives to develop the treatments in the first place.

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Aug. 6 Webinar Wednesday: 'Where am I? Finding and Impacting Members to Improve Quality Ratings, Reduce Administrative Costs, and Transform Processes'
LexisNexis
The changing landscape of healthcare has only increased our dependency on member and provider data to fuel administrative processes, quality initiatives and coordination of care. With more than half of Medicaid enrollees being assigned to managed care organizations, data provided by states and other entities on these members are critical to supporting your efforts to locate, enroll and manage their health and costs.

In this webinar, you will:
  • Get a better understanding of the seriousness of data quality issues across healthcare
  • Discover new ways to verify, augment and monitor provider and member data
  • Hear real-world case studies where data quality issues were identified and resolved to drive quality and performance ratings, efficiency and savings

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TRENDING ARTICLES
Missed our previous issues? See which articles your colleagues read most.

    North Carolina governor: 'Door open' to Medicaid expansion (The Washington Post)
Texas state agency prepares to expand STAR+PLUS program (The Athens Review)
NC Senate, House at odds over future of Medicaid (The Associated Press via Salisbury Post)
State governments may spend $55 billion on hepatitis C medications (PRNewswire via MarketWatch)
Oregon moves closer to limiting access on hepatitis C drugs as Senate investigation begins (The Oregonian)

Don't be left behind. Click here to see what else you missed.


Aetna job opportunities
Aetna
The following are job opportunities from Aetna. Visit here, and enter Req # for full description and details.
    MD/Psychiatrist; Newark, Delaware; Req# 19223BR
    This successful candidate will become the Delaware Physicians Care (DPCI) Medical Director for Behavioral Health and will serve as our expert physician resource in the areas of utilization management, quality management, case management and overall medical management. This critical role sits at the intersection of behavioral and physical health services in helping DPCI to develop holistic programs to improve the quality and outcomes of our constituent members.

    MD/Physical Health; Newark, Delaware #19166BR
    The position entails duties and responsibilities of Medical Director for Delaware Physicians Care (DPCI). The successful candidate will serve as a critical contributor to the DPCI medical management team in the role of clinical expert to the various functional areas including utilization management, case management and quality management. A key component of this position is to use the clinical credentials, experience and judgment in rendering benefit determinations based on medical necessity.

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