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The Hill
The Obama administration is stepping up its involvement in the debate over drug prices, sending letters to pharmaceutical companies and state Medicaid programs on Thursday asking questions about cost and access.
The Centers for Medicare and Medicaid Services sent letters on Thursday to both sides in the drug pricing debate. On one hand, it sent letters to drug companies asking about pricing arrangements that they have with state Medicaid programs and ways to assist states with making high-price drugs affordable.
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Bloomberg
Drugmakers including Gilead Sciences Inc. and AbbVie Inc. were contacted by the U.S. government's Medicaid agency to discuss options for how to pay for hepatitis C cures whose costs have eaten into state budgets.
The companies, along with Johnson & Johnson and Merck & Co., were asked in letters from the Centers for Medicare and Medicaid Services to provide information on arrangements they make with health insurers to link payments to the outcomes of their treatments. Such arrangements may affect the prices that drugmakers are required to offer under the Medicaid program, the agency said Thursday.
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Pharmalot
The Centers for Medicare and Medicaid Services wrote four drug makers asking for information about pricing arrangements with insurers and pharmacy benefits managers.
"The fact that CMS sent letters to each of the companies that make hep C drugs to remind them of their ethical responsibility to patients is a big deal," said Jeff Myers, chief executive officer and president of Medicaid Health Plans of America. "It highlights the unsustainability of their current pricing model."
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The Wall Street Journal
The Justice Department has ratcheted up the scrutiny of drug-pricing practices with a new round of inquiries over how pharmaceutical companies report product prices to the government Medicaid program.
The U.S. Attorney's Office for the Eastern District of Pennsylvania and the Justice Department's civil division are seeking information from Valeant Pharmaceuticals International Inc. and Eli Lilly & Co. about how they calculate and report drug prices for the Medicaid rebate program, the companies disclosed in filings to the Securities and Exchange Commission in recent weeks.
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Modern Healthcare
The CMS has revealed that it underpays health plans that enroll large numbers of people who are dually eligible for Medicare and Medicaid, and the agency plans to modify its risk-adjustment model to make up for the underpayment.
"We are heartened that CMS has responded to several data analyses that indicate a clear correlation between the socioeconomic status of dual-eligibles and the effect they have on predicting their costs," said Jeff Myers, CEO of the trade group Medicaid Health Plans of America. "Our hope is that this move will truly level the playing field for Medicaid plans that are serving those with significant health challenges in this vulnerable population."
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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MHPA
See you there! http://bit.ly/mhpa2015.
The Plain Dealer
Two recent independent studies gave Ohio high marks for efforts to allow Medicaid patients to stay in home and community settings rather than in institutions. The studies focused on care for those needing long term support services — generally the elderly — and those needing mental health services. Options that allow Medicaid clients to remain in community settings generally cost less than institutions.
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The Wichita Eagle
Medicaid will cost the state of Kansas more than the legislature expected when it passed a budget in June. Budget officials met last week to review caseloads for the state's Medicaid, foster care, and welfare systems, determining that the overall cost of the state’s human services would be $48.9 million more than the amounts approved by the legislature.
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Los Angeles Times
Half of Californians in the country illegally would be eligible for the state’s healthcare program for the poor if it were expanded under a proposal by legislators, a new report finds. Some California politicians are pushing to open up the $91-billion Medi-Cal program to people here illegally, since such immigrants are not allowed to sign up for insurance under Obamacare.
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The Washington Post
Amid the coal fields of eastern Kentucky, a small clinic that is part of the Big Sandy Health Care network furnishes daily proof of this state's full embrace of the Affordable Care Act. It was here that Mindy Fleming handed a wad of tissues to Tiffany Coleman when she arrived, sleepless and frantic, with no health insurance and a daughter suffering a 103-degree fever and mysterious pain.
Such one-by-one life changes are the ground-level stakes ushered in by the election last week of businessman Matt Bevin as Kentucky's next governor. The second Republican elected to the office in 48 years, he wrapped his campaign around a pledge to dismantle Kynect, the state’s response to the federal healthcare law. If he follows through, the Bluegrass State would go from being perhaps the nation's premier ACA success story to the first to undo the law's results, razing a state insurance exchange and reversing its considerable expansion of Medicaid.
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New Hampshire Public Radio
A bipartisan commission says New Hampshire lawmakers should consider adding comprehensive dental benefits to the state's Medicaid program for adults. The commission, which was created last year to analyze barriers to dental care in New Hampshire, released its final report on Monday. It found that the state does well on some measures, such as having the lowest percentage of third-graders with untreated tooth decay, but did worse on others. For example, about a quarter of New Hampshire adults haven't visited a dentist in the last year.
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With an emphasis on innovative initiatives and data-driven solutions, DentaQuest is partnering with health plans to fundamentally change the way oral health is delivered in America. Integrating preventive oral health programs not only offers members a wider portfolio of choice - it is also a proven driver of cost control.
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Health Affairs
Efforts to expand Medicaid while controlling spending must be informed by a deeper understanding of the extent to which the high medical costs associated with severe obesity (having a body mass index of Formula or higher) determine spending at the state level. Our analysis of population-representative data indicates that in 2013, severe obesity cost the nation approximately $69 billion, which accounted for 60 percent of total obesity-related costs.
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RxAnte
Use of prescription opioids has grown rapidly in recent years. These powerful medications bring enormous value to many patients, but they also pose significant safety and cost concerns. The cost of opioid abuse in the United States was recently estimated to be $70 billion annually and led to nearly 100,000 avoidable ER visits each year. Most policy and clinical approaches to this problem focus on identifying individuals who divert abuse or otherwise misuse opioids — referring them to programs aimed at treating addiction or reducing fraud, waste and abuse. Relatively few programs aim to prevent potentially unsafe opioid use from developing in the first place.
Join, Michael Ross, M.D., chief medical officer, and Amie Joyce, MPH, vice president of account management of RxAnte, LLC. This webinar will describe a novel program that enables healthcare payers and providers to prevent potentially unsafe opioid use.
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MHPA
View and listen to the webinar recording.
View other past webinars here.
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