Morning Briefing
Summaries of health policy coverage from major news organizations
CMS Responds To Pharma Offers In Medicare Drug Price Negotiations
Politico: CMS Rejects Drugmaker Price Offers, Kick-Starting Medicare Talks
CMS said Tuesday it shot down drugmakers’ price offers for 10 pharmaceuticals subject to Medicare price negotiations, kicking off talks expected to stretch through the summer. The agency’s decision is the latest development in a negotiation process created by the Inflation Reduction Act. Officials touted the prospect of savings for those on Medicare, but the final prices won’t take effect until 2026. (King, 4/2)
Reuters: US Takes Next Step In Medicare Drug Price Negotiations With Pharma Companies
The agency overseeing Medicare, the Centers for Medicare and Medicaid Services (CMS), picked the first 10 drugs for negotiation in August and sent its initial price offers in February. The companies involved had until March 1 to respond and all did so. Each company can meet with CMS up to three times for further negotiations before a final price is announced on Aug. 1. The negotiated prices will come into effect in 2026. (4/2)
In other news —
CNBC: Health Insurer Stocks Slide As Medicare Advantage Rates Disappoint
Shares of U.S. health insurers fell Tuesday after the Biden administration didn’t boost payments for private Medicare plans as much as the insurance industry and investors had hoped. (Constantino, 4/2)
Modern Healthcare: CMS Finalizes Network Rules For Exchange Plans
The Centers for Medicare and Medicaid Services made some tweaks to the health insurance exchanges in a final rule published Tuesday. The regulation establishes network adequacy standards based on the time and distance patients have to travel for in-network care beginning in 2026 and aligns the annual open enrollment period for state-based exchanges with the federal sign-up campaign. The final rule is consistent with what the agency proposed in November. (Berryman, 4/2)
The Wall Street Journal: Medicare Keeps Getting Tougher For Health Insurers
Medicare Advantage plans had already been facing an unusual rise in medical costs. Now, the payments they get from the government also are squeezing them from the other side. Late Monday, the Centers for Medicare and Medicaid Services announced it would leave an earlier payment proposal unchanged, which came as a big disappointment to investors who had expected an increase. On Tuesday morning, insurance giants were tumbling, with Humana declining nearly 10%. Centene and UnitedHealth were down by less. (Wainer, 4/2)
Bloomberg Law: Rural Hospitals Seek Help As Private Medicare Patients Increase
Rapid enrollment growth in Medicare managed care plans is creating another layer of economic uncertainty for beleaguered rural hospitals. The number of rural beneficiaries enrolled in private Medicare Advantage plans jumped nearly 48%, from 6.3 million to 9.2 million, between 2019 and 2023, according to health consulting firm Chartis. By 2023, 44% of rural beneficiaries were enrolled in MA plans, according to the Medicare Payment Advisory Commission. But rural hospitals say MA plans often pay less than traditional Medicare, don’t cover as many services, and are more likely to deny or delay coverage through prior authorization. (Pugh, 4/3)
Also —
MPR News: ‘Overdue For Action’: Pharmacists Press For Financial Help, Changes To Prevent Closures
Independent pharmacists on Tuesday urged lawmakers to take action to boost their Medicaid reimbursement rates to help them stay afloat financially. Without a lifeline, a group representing pharmacists said some around the state would have to close their doors in coming months. The request comes as more independent pharmacies face financial strains. Roughly 34 percent of independent pharmacies closed between 2018 and 2023, compared to 20 percent of retail pharmacy chains. (Ferguson, 4/2)
Crain's Chicago Business: Walgreens Medicare-Medicaid Whistleblower Lawsuit Moves Forward
A federal judge has given the green light for a whistleblower lawsuit contending that Walgreens violated U.S. and Illinois false claims statutes by steering Medicare and Medicaid patients to its own pharmacy by waiving co-pays. In a case that's been kicked around for about a decade after several amendments and the U.S. and Illinois governments trying to hop aboard, Judge John F. Kness, of the U.S. District Court for the Northern District of Illinois ruled on March 29 that the complaint brought by two former Walgreens pharmacy technicians could continue. (Asplund, 4/2)
NPR: Mental Health Care Is Hard To Find, Especially If You Have Medicare Or Medicaid
With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency, the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday. The report ... finds that Medicare and Medicaid have a dire shortage of mental health care providers. (Chatterjee, 4/3)
