How Much Will Insured Medicines Cost? Most Americans Haven’t A Clue

Axios: Insured Americans Can't Predict Drug Costs: Survey
More than half of insured Americans say they can't predict how much their covered prescription drugs will cost, according to an annual survey by the pharmaceutical industry trade group PhRMA. The results, shared first with Axios, come as the drug industry is pressing for more transparency regulations on pharmacy benefit managers and insurers in the lame-duck period following the election. (Goldman, 10/28)

The New York Times: How Taxpayers Are Helping Health Insurers Make Even Bigger Profits 
Health insurers have made an enticing pitch to local governments across the country: When your workers see doctors outside your health plan’s network, costs can balloon, but we offer a program to protect against outrageous bills. Cities, counties and school districts have signed up, hoping to control the costs of their medical benefits. Then come the fees. (Hamby, 10/28)

Modern Healthcare: False Claims Act Challenged By Whistleblower Lawsuit Verdict
Healthcare companies would likely spend less time and money litigating whistleblower lawsuits if a recent federal court ruling holds. U.S. District Court of the Middle District of Florida Judge Kathryn Kimball Mizelle ruled late last month whistleblowers could not file False Claims Act lawsuits on behalf of the federal government. The opinion diverged from five other cases evaluating the constitutionality of the act’s qui tam provisions, but still casts doubt on a widely used tool designed to root our fraud in the healthcare industry. (Kacik, 10/25)

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The Boston Globe: UMass Memorial Health CEO Predicts More Massachusetts Hospital Closures
UMass Memorial Health chief executive Eric Dickson has a grim diagnosis for the state’s health care system: Without a dramatic change, more closures will likely follow the recently shuttered Carney and Nashoba Valley hospitals. Those two hospitals went dark in large part because of their for-profit ownership under the now-bankrupt Steward Health Care, which undermined their future by selling their real estate. (Chesto, 10/25)

Houston Chronicle: Blue Cross Blue Shield Medicare Advantage Pulling Out Of MD Anderson
Patients covered by Blue Cross Blue Shield of Texas Medicare Advantage and Medicaid insurance plans will lose in-network access to MD Anderson Cancer Center next week, according to a statement on the cancer hospital's website. By Nov. 1, the hospital's agreement with the insurer's Medicare Advantage and Medicaid plans will expire, meaning patients on those plans will no longer be charged heavily discounted rates for care. Medicare Advantage plans are offered by private insurance companies and, like original Medicare, cover people over the age of 65 or people with certain disabilities. (Gill, 10/25)

Bloomberg: UnitedHealth, Amedisys To Make Last Push For DOJ Blessing On Deal
UnitedHealth Group Inc. and Amedisys Inc. representatives are slated to meet with top Justice Department antitrust enforcers next week in a last-ditch effort to persuade the agency not to challenge their proposed tie-up, according to people familiar with the matter. The high-stakes meeting between the companies and DOJ antitrust leadership, including Assistant Attorney General Jonathan Kanter, is typically the last step before officials decide whether to file a lawsuit. It’s often referred to as a “last-rites” meeting. (Sisco, 10/25)

Modern Healthcare: Centene Sees Medicaid Pay Bump But Execs Say It's Not Enough
Centene continues to lobby states for additional Medicaid funding as higher spending and a small revenue decline squeezed the company in the third quarter, Chief Financial Officer Drew Asher told investor analysts Friday. Although the health insurance company won rate increases averaging 4.5%-5% in all the states where it administers Medicaid benefits, they weren't enough to prevent Medicaid revenue slipping 1% to $21.3 billion during the quarter, Asher said. The Medicaid medical loss ratio, which measures the share of payments spent on care, rose from 90.7 to 93.1%. (Tepper, 10/25)