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The Hill
President Barack Obama's top health official said Thursday that the uproar over EpiPen pricing shows why the federal government should have the power to negotiate drug costs. Health and Human Services Secretary Sylvia Mathews Burwell said drug prices would be better controlled if Medicare and Medicaid could directly push pharmaceutical companies to lower costs.
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Kaiser Health News
Specialty drug costs jumped 30 percent last year to $587 million for the California Public Employees' Retirement System, one of the nation's largest health care purchasers. Though they amount to less than 1 percent of all prescriptions, specialty drugs accounted for more than a quarter of the state agency's $2.1 billion in total pharmacy costs. Those overall drug costs have climbed 40 percent since 2010.
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The Pew Charitable Trusts
Can states save money on increasingly expensive prescriptions for Medicaid patients by setting prices based not on drugmakers' wishes, but on how well the medicines control, contain or cure disease? The notion of tying drug payments to results, called "pay-for-performance pricing" or "value-based pricing," already is being tested by some health insurance companies, some pharmaceutical companies and Medicare. And just last week, the Oregon Health & Science University announced it will undertake a large-scale research project to examine how states could apply the concept to Medicaid.
Something has to give, said Jeff Myers, CEO of Medicaid Health Plans of America, the trade association representing Medicaid managed care plans. "A system in which the manufacturers are pricing to get the most money out of taxpayers isn't workable," he said.
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AIS
Advanced data, analytics and social determinants of health were just a few of the running themes at the Medicaid Health Plans of America's mhpa2016 conference, which took place in Washington, D.C., from Sept. 21-23. Here's what some of the speakers had to say on the importance of these elements in providing personalized and cost-effective care for managed Medicaid beneficiaries.
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Modern Healthcare
Some want to opt out of a CMS rule effective this week that's meant to ensure Medicaid beneficiaries have adequate access to care. State officials say the rule is outdated and a waste of administrative resources. But scofflaws could see their federal funds withheld if they don't comply. Last year, the CMS finalized a rule requiring states to assess how easy it is for fee-for-service Medicaid beneficiaries to receive primary care and pre- and post-natal obstetric services and see specialists and behavioral health experts, among other services.
"We have a tiny fee-for-service population," said Justin Senior, deputy secretary of the Division of Medicaid in Florida at the 2016 Medicaid Health Plans of America last week. "We're having to do as much work under the access rule as we are to comply with the managed Medicaid rule. It doesn't make any sense."
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The Arizona Republic
Gov. Doug Ducey's plan to modernize Arizona's Medicaid program won approval Friday from the federal Centers for Medicare & Medicaid Services, but the approved plan does not include a job-search requirement or five-year limit on benefits that the governor had sought. The letter from Acting CMS Administrator Andrew Slavitt states the Arizona Medicaid demonstration, called Arizona Health Care Cost Containment System (AHCCCS) is extended five years through Sept. 30, 2021.
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The Salt Lake Tribune
Utahns eligible for the state's small-scale Medicaid expansion plan, even if it is approved by the federal government, likely will be unable to enroll in the program on the estimated Jan. 1 start date. The plan, projected to cover 9,000 to 11,000 people, recently underwent federal public comment. It targets childless adults who are chronically homeless, involved in the justice system or in need of mental-health or substance-abuse treatment. It also expands coverage of low-income parents with dependent children previously not covered by Medicaid.
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Idaho Statesman
Following more than two hours of impassioned public testimony, a legislative panel reviewing health care options for thousands of Idaho's working poor acknowledged Wednesday that it does not expect to reach consensus on what if any action to recommend to the full legislature.
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