Drug Pricing Law Savings May Disappoint, Budget Experts Warn
The government bill for the law might mean less cash will be saved than hoped, Stat reports. The Medicare Part D drug benefit is estimated to cost $10 billion to $20 billion more in 2025 than projected. Meanwhile, Texas sues PBMs, drugmakers over insulin pricing.
Stat:
Savings From Drug Pricing Law Will Be Smaller Than Expected: CBO
A key aspect of the Democrat-passed law to lower drug prices is significantly more expensive to the government than expected, according to nonpartisan budget experts in Congress. The redesign of the Medicare Part D drug benefit will cost $10 billion to $20 billion more next year than the Congressional Budget Office initially projected. That office estimates that a separate recently announced program to pay insurers to lower drug premiums will cost $5 billion. (Wilkerson, 10/3)
Fierce Healthcare:
Texas Sues PBMs, Manufacturers Over Insulin 'Conspiracy'
The state of Texas is accusing major pharmacy benefit managers and drug companies of colluding to raise the cost of insulin. Texas alleged drug manufacturers Eli Lilly, Novo Nordisk and Sanofi raise the price of insulin and then pay an undisclosed amount back to PBMs Optum Rx, Express Scripts and CVS Caremark through a quid pro quo agreement. PBMs then give preferred status on its standard formularies to drugs with the highest list prices, the state said. (Tong, 10/3)
On hospital costs —
Fierce Healthcare:
GAO Wants CMS To Take Deeper Look At Hospital Price Transparency
The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. On instruction from Congress, the GAO conducted a review of the requirements, the CMS’ enforcement and whether the agency’s policy was successfully serving patients, payers and researchers. (Muoio, 10/3)
San Francisco Chronicle:
Health Care Workers In California To Get Delayed Minimum Wage Increase
California health workers this month will finally get a long-promised minimum wage increase. It’ll kick in this month, according to a letter state health officials sent to the Legislature Oct. 1, describing a process that should trigger the pay boost. “The health care minimum wage increases shall be effective 15 days after the date of this notification, on October 16, 2024, unless a later effective date is specified,” Michelle Baass, the director of the California Department of Health Care Services wrote in the letter. (Ibarra, 10/3)
In news about Obamacare —
Modern Healthcare:
How Harris, Trump May Affect ACA Markets Post-2024 Election
The 2024 elections hold the possibility of dramatic changes for the health insurance sector as the presidential contest between Vice President Kamala Harris and former President Donald Trump reveals very different visions for the future. Yet the Democrat Harris and the Republican Trump may not act as expected when they confront key issues from the White House. And the outcome of the congressional elections that determine control of the House and Senate will pose different obstacles and opportunities to whoever is the new president. (McAuliff, 10/3)
NBC News:
GOP Senator Eyes Health Care Overhaul And Extending Trump Tax Cuts In One Big 2025 Bill
As Donald Trump calls for overhauling the Affordable Care Act with a new health care system, a Republican senator running for an influential leadership position says the party should combine that pursuit with a major tax bill in the new year. Sen. Tom Cotton, R-Ark., told NBC News after the vice presidential debate in New York on Tuesday night that if voters elect Trump and a GOP-controlled Congress, Republicans will be able to “make health care more affordable, more tailored and more personalized than the one-size-fits-all option,” referring to the ACA, or Obamacare. (Haake and Kapur, 10/2)
On Medicare Advantage —
Modern Healthcare:
UnitedHealthcare Sues Over Medicare Advantage Ratings Downgrade
UnitedHealthcare has filed a lawsuit against the Centers for Medicare and Medicaid Services, alleging the government agency lowered its Medicare Advantage star ratings based on one test phone call that lasted less than 10 minutes. The insurer is the latest to sue CMS over star ratings. (DeSilva, 10/3)
Stat:
Medicare Advantage Market Expected To Grow In 2025, Despite Big Changes From Insurers
Next year’s Medicare Advantage market will be two things at once: remarkably stable broadly, but rife with changes under the surface. Health insurance companies will still offer older adults a lot of plan choices with low, or completely free, premiums. That’s why the federal government expects enrollment in the $500 billion Medicare Advantage program to grow once again in 2025 — a stark contrast from insurers’ cries that modest payment reforms would damage them and seniors’ options. (Bannow and Herman, 10/4)
