Morning Briefing
Summaries of health policy coverage from major news organizations
1 In 3 Americans Has Cut Back Daily Spending To Pay For Health Care
The Washington Post: One-Third Of Americans Skip Meals Or Other Needs To Afford Health Care
Americans are driving less, skipping meals and putting off big life moves, like buying homes or having children, to keep up with health care costs, according to two Gallup polls released Thursday. Roughly one-third of Americans are cutting back on daily spending to cover medical costs, and about half of middle-income households said they have delayed a major life event because of the same expenses, the polls found, as premiums rise and the federal government cuts Medicaid spending. (Wu, 3/12)
On SNAP benefits —
The New York Times: Food Stamp Recipients Sue Over Bans On Sugary Drinks
Food stamp recipients sued the Agriculture Department on Wednesday over restrictions barring them from using their benefits to buy sugary drinks and candy, arguing that the limits are unlawful, create confusion and add to their difficulties in managing their health. Since May, the department has approved waivers in 22 states that allow them to bar participants in the Supplemental Nutrition Assistance Program from using their benefits to buy soda, energy drinks, candy or other prepared desserts. (Qiu, 3/11)
On the high cost of prescription drugs —
Modern Healthcare: PBMs Shift From Rebates To Fees To Make Up For Lost Revenue
Pharmacy benefit managers are moving away from imperiled contractual arrangements to sustain profit margins. PBMs, especially market leaders UnitedHealth Group’s Optum Rx, CVS Health’s CVS Caremark and Cigna’s Express Scripts, withstood criticism for years over how they managed pharmaceutical rebates and engaged in spread pricing for medicines. Now that federal and state governments are writing laws and regulations to crack down on those practices, PBMs are predicted to make up for the lost revenue by imposing larger fees on employer-sponsored health plans and drugmakers when they draw up contracts with clients. (Tong, 3/11)
The Washington Post: How GLP1s Are Changing The Ways Americans Buy Medicine
Ashley Elizabeth Harden logged on recently from her home in small-town Louisiana and searched for a weight-loss drug. She found plenty of options and settled on a cheaper, imitation version of the name-brand drugs for $177 a month that she could buy without going through insurance. “It’s absolutely odd,” she said of paying a cash price for medicine she sees as vital but whose cost rivals her monthly electric bill, “having to research, compare prices and make decisions online for something so important just to access it.” (Rowland, 3/12)
Becker's Hospital Review: Inflation Reduction Act Tied To Stronger Medication Adherence: Study
Cost-related medication nonadherence declined among Medicare enrollees following implementation of the Inflation Reduction Act’s prescription drug provisions in 2024, according to a study published March 9 in JAMA Internal Medicine. Enrollees’ cost-related medication nonadherence fell by an estimated 4.9 percentage points relative to privately insured comparators after the provisions took effect. (Cerutti, 3/11)
On Medicare costs —
Modern Healthcare: Aetna To Pay $118M To Settle Medicare Advantage Upcoding Claims
Aetna will pay $117.7 million to resolve False Claims Act allegations that it overbilled the Medicare program. The agreement settles claims related to past risk adjustment submissions dating back nearly a decade, the U.S. Attorney’s Office for the Eastern District of Pennsylvania said in a Tuesday news release. Part of the settlement relates to a sealed whistleblower lawsuit filed by former Aetna risk-adjustment coding auditor Mary Melette Thomas, the release said. (Tepper, 3/11)
Modern Healthcare: CMS Ambulatory Specialty Model Sparks Pay Concerns From Providers
A pending Medicare payment model meant to improve care for chronic conditions has some providers worried it could have the opposite effect. The mandatory, five-year Ambulatory Specialty Model demonstration for fee-for-service Medicare starts in 2027 and aims to promote identification and management of heart failure and lower back pain. The two-sided risk model could impact reimbursements by as much as 9% in its first year, and it establishes a payment structure that assesses providers against regional peers. (Early, 3/11)
MedPage Today: Oz Didn't Invent The Medicare Fraud Fight. Is He Changing It?
For decades, the federal government took a simple approach to Medicare and Medicaid fraud: Pay first, chase later. Now there is, apparently, a "war room." In a viral social media clip, a dozen staffers sit around a conference table, laptops open, TV screens behind them. "These open buildings that they claim are medical facilities," one analyst says on camera. "Nobody's there." CMS Administrator Mehmet Oz, MD, MBA, nods. They are, he says, "holding their feet to the fire." (McCreary, 3/11)
