House Panel Advances Bill To Restrict PBMs To Charging Flat Service Fees
The bipartisan measure on pharmacy benefit manager reforms would also ban spread pricing — a common PBM practice of charging insurers more than they pay pharmacies.
Stat:
House Panel Passes PBM Reforms For Sliver Of Commercial Market
A House panel passed a bipartisan bill to ban drug middlemen from charging fees based on drug list prices — the first in Congress’ raft of PBM reform efforts that would actually ban the practice in at least some of the employer-sponsored insurance market. (Wilkerson, 2/6)
CNN:
Medicare Now Negotiating Price Of Drug That Costs $7,100 In US Vs. $900 In Canada
Sen. Bernie Sanders is once again taking the pharmaceutical industry to task, issuing a report Tuesday that highlights the cost of three blockbuster drugs that are far pricier in the US than in other countries. The differences are striking. The annual list price of Bristol Myers Squibb’s Eliquis, a blood thinner that reduces the risk of stroke, is $7,100 in the US. But in Japan, it’s $940; in Canada, it’s $900; in Germany, it’s $770; in the United Kingdom, it’s $760; and in France, it’s $650. (Luhby, 2/6)
Axios:
How Trump Could Weaken Medicare Drug Pricing Negotiations
If Donald Trump returns to the White House, the self-proclaimed master negotiator could get his shot at brokering Medicare prices for drugs. Trump first ran for president bucking conservative orthodoxy by vowing to negotiate drug prices, though he later abandoned that pledge. But the Democrats' drug pricing law would require the GOP frontrunner to negotiate Medicare prices for some drugs if he wins a second term, and former Trump health officials expect he would use executive power to soften the government's approach. (Goldman, 2/7)
More about Medicare —
Rolling Stone:
Republicans Are Planning To Totally Privatize Medicare If Trump Wins
As Rolling Stone has detailed, the proposed Project 2025 agenda is radically right-wing. One item buried in the 887-page blueprint has attracted little attention thus far, but would have a monumental impact on the health of America’s seniors and the future of one of America’s most popular social programs: a call to “make Medicare Advantage the default enrollment option” for people who are newly eligible for Medicare. Such a policy would hasten the end of the traditional Medicare program, as well as its foundational premise: that seniors can go to any doctor or provider they choose. The change would be a boon for private health insurers — which generate massive profits and growing portions of their revenues from Medicare Advantage plans — and further consolidate corporate control over the United States health care system. It would not likely benefit seniors, since the private plans limit the doctors they can see and often wrongfully deny patients’ care. (Perez, 2/5)
Modern Healthcare:
Centene May Trim Medicare Advantage Benefits Over CMS Rate Cut
Centene may scale back Medicare Advantage benefits if the Centers for Medicare and Medicaid Services carries out a rate cut next year, executives said Tuesday. The health insurance company is the latest to report higher-than-expected costs for its Medicare Advantage members and to bemoan a CMS proposed rule that would trim benchmark payments by 0.16% in 2025, excluding the effects of risk adjustment. That wouldn't be enough to cover expenses, CEO Sarah London said during a call with investor analysts to announce fourth-quarter and full-year earnings. (Tepper, 2/6)
Modern Healthcare:
CMS Medicare Advantage AI Guidance Issued
Medicare Advantage insurers may utilize artificial intelligence and other technologies to assess coverage decisions, but the tools cannot override benefits rules and medical necessity standards, the Centers for Medicare and Medicaid Services wrote in a notice to health insurance companies Tuesday. UnitedHealth Group, Humana and Cigna each is fighting lawsuits alleging they utilize AI, algorithms and similar utilities to routinely decline coverage for post-acute care and other services. (Bennett, 2/6)
