Senate Panel Passes Package Of Reforms That Would Limit PBMs

Stat: Senate Panel Clears PBM, Hospital Reforms 
A prominent Senate panel on Wednesday passed a new package of health policy reforms that would rein in certain pharmacy middlemen practices and ensure Medicare patients aren’t paying more than insurers do for medications. The package passed the committee 26-0 with no amendments added. (Cohrs, 11/8)

Modern Healthcare: Senate PBM Bill Passes Finance Committee
Congressional pressure on pharmacy benefit managers continued to mount Wednesday as the Senate Finance Committee approved another bipartisan measure to curb the industry's business practices. The panel voted 26 to 0 to refer the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 to the full Senate, with Sen. Ron Johnson (R-Wis.) declining to cast a vote. (McAuliff, 11/8)

Also —

Modern Healthcare: Senate Moves To Delay $16B Hospital Cut, Trim Doctor Pay Hit
The Senate Finance Committee approved the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023, which would delay pending reductions in Medicaid disproportionate share hospital funding for safety-net facilities, scale back a Medicare pay cut for physicians that the Centers for Medicare and Medicaid Services finalized last week, extend expiring healthcare programs, expand Medicare coverage of mental healthcare and impose new limits on pharmacy benefit managers. (McAuliff, 11/8)

Stat: Ambulance Rides For Just $100? Advisers Want Major Billing Fixes
A panel of government advisers finally has endorsed ideas for Congress to solve the particularly thorny problem of surprise ambulance bills, including a cap on how much patients would have to pay if they took an ambulance. (Herman and Bannow, 11/9)

More on Medicare and insurance coverage —

Stat: Medicare Solvency Divides Republicans At The Presidential Debate
Republicans angling for the party’s presidential nomination on Wednesday grappled with the reality that the Medicare program could start running out of money within the next president’s eight-year term. (Cohrs and Owermohle, 11/8)

Healthcare Finance News: Medicare Advantage Beneficiaries See Better Health Outcomes 
People with Medicare Advantage tend to have stronger health outcomes than those with fee-for-service Medicare, seeing fewer hospitalizations and readmissions, according to research published by Inovalon. Using its unique data assets and analytics to look at a broad range of quality measures across care settings, the research shows that patients enrolling in MA realize substantially reduced rates of chronic and acute care complications. (Lagasse, 11/8)

WDRB: As Humana-Baptist Feud Drags On, Medicare Patients Caught In Middle 
Disputes between insurers and Baptist Health — one of the three large provider systems in Louisville — highlight the other side of the Medicare Advantage equation. (Otts, 11/7)

Axios: Health System Grapples With Coverage Of New Digital Therapies
A wave of medical services delivered via software has the potential to expand access to new therapies and help keep people out of the hospital — but the health system is still trying to figure out how to pay for it. Experts advising Medicare are just beginning to wrestle with how the program — the largest payer of health care in the U.S. — should pay for software used as medical devices, which can range from video games prescribed for ADHD to technology that analyzes data from CT scans. (Goldman, 11/9)

Reuters: Three Tips To Maximize Benefits During Open Enrollment 
Poring over complicated issues like health insurance can feel like drudgery that we want to avoid. More than two out of three employees (67%) spend less than 30 minutes reviewing benefits options during open enrollment season, while almost half spend less than 20 minutes, a new Voya Financial survey shows. Yet the average American spends more than two hours a day on social media. (Taylor, 11/8)