Patient Groups Try Calling Medicare Officials Villains Over Aduhelm Ruling
Politico covers aggressive pushback from drugmakers and patient advocacy groups over the recent decision to strongly limit Medicare coverage of Alzheimer's drug Aduhelm. Meanwhile, Axios says six big health insurers dominate the fast-growing Medicare Advantage market.
Politico:
‘Not A Tolerable Situation’: Patient Groups Take Aim At CMS Over Alzheimer’s Coverage Decision
Drugmakers and patient advocacy groups are waging a campaign to cast Medicare officials as villains after the program limited coverage of a pricey new Alzheimer’s drug and demanded tougher criteria than the FDA to prove it works. Their goal is to strong arm the Centers for Medicare and Medicaid Services into covering Aduhelm, the $28,200-per-year drug, for far more people. (Foley and Wilson, 1/17)
And more about the insurance industry —
Axios:
UnitedHealth, Other Big Medicare Advantage Insurers Dominate 2022
Six health insurers control roughly three-quarters of the fast-growing Medicare Advantage market, according to an Axios analysis of federal data. Medicare Advantage enrollment hasn't slowed down in 2022, even though dismal projections from Humana and Cigna freaked out Wall Street earlier this month, and concentration at the top remains high. (Herman, 1/19)
Axios:
Insurers May Face Scrutiny Over Birth Control Coverage
Health insurers could face increased scrutiny and potential enforcement actions regarding their coverage of birth control, following recent guidance from the Biden administration. The ACA requires birth control coverage with no cost-sharing, but some advocates and Democrats in Congress have said insurers are running afoul of the law with restrictions. (Reed, 1/18)
KHN:
HHS Proposal For Marketplace Plans Carries A Hefty Dose Of Consumer Caution
Some insurance brokers are enrolling people into Affordable Care Act health plans without their consent, perhaps for the commissions, a move that could put consumers in danger of owing back the subsidies connected with the coverage. The damage could be hundreds or even thousands of dollars. A consumer’s first hint that something is wrong is a big one: a letter from the IRS or a delay in their tax refund. (Appleby, 1/19)
In other health care industry updates —
Crain's Detroit Business:
Bottleneck In Acute Care Pipeline Leaves Patients With Nowhere To Go
Last week, case managers at Sparrow Specialty Hospital in Lansing finalized the transfer of a patient. She had contracted COVID-19 nearly three months earlier and required a tracheotomy, a common practice in critically-ill patients with a prolonged need for a ventilator. She was ready to leave Sparrow Specialty's care many weeks earlier but staffing, transportation and beds are in short supply. Sparrow Specialty's case managers sent 60 transfer requests for the patient before a room opened up at Mary Free Bed only one floor above. (Walsh, 1/18)
Modern Healthcare:
FTC, DOJ Ask For Public Input In Antitrust 'Overhaul'
The FTC has asked several of the major insurers for data on hospital acquisition of physicians as the healthcare sector continues to vertically consolidate. It is also reworking its vertical merger guidelines, which are expected to bolster an enforcement area where regulators have historically had limited success. About 90% of acute-care markets in metro areas are highly concentrated, lawmakers have said, noting that many hospitals amass market power through small transactions that skirt regulatory review. Most hospital mergers raise prices and stunt quality, research shows. (Kacik, 1/18)
