Author: Peter

Nevada Medicaid approved a requirement that therapists receive prior approval before providing more than five therapy sessions to a patient...The new policy, which takes effect on Oct. 1, will require psychologists, therapists and other mental health providers to submit written documentation to the state’s third-party vendor demonstrating the medical necessity of treatment and receive prior approval to continue providing both talk therapy and neurotherapy services after five sessions with a patient. The final policy is a scaled back version of earlier proposals from Medicaid to require prior authorization before the first session or after three sessions, both which received significant pushback from the mental health community over the last few weeks...The policy will only apply to patients enrolled in Medicaid’s fee-for-service program, in which Nevada Medicaid reimburses individual providers for services rendered, and not those who are covered under Medicaid managed care, where the state pays an insurance company a flat fee to provide health services to a patient. About one in four of the 650,000 Nevadans on Medicaid are enrolled in the fee-for-service-program.

Three chambers of commerce in Southern Nevada are banding together to take advantage of a new Trump administration rule that makes it easier for small businesses to collectively purchase health insurance...The Henderson Chamber of Commerce, Latin Chamber of Commerce and Boulder City Chamber of Commerce have partnered under the banner of the Clark County Health Plan Association to offer so-called association health plans to their members...The Department of Labor released a rule in June that loosened the rules on association health plans, exempting them from providing the essential health benefits required under the Affordable Care Act, eliminating restrictions based on geography and allowing companies in different industries in the same region to provide coverage together.

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Albertsons and Rite Aid on Wednesday evening announced that they had mutually decided to terminate the proposed merger...The termination came a day before Rite Aid was set to hold a special shareholders meeting at which the company has been urging its shareholders to vote in favor of the merger...“Albertsons believes that the strategic rationale of the Rite Aid combination was compelling, including the $375 million of cost synergies and $3.6 billion of identified revenue opportunities,” Albertsons said. “We disagree with the conclusion of certain Rite Aid stockholders and third-party advisory firms that although they acknowledged the strategic logic of the combination, did not believe that Albertsons was offering sufficient merger consideration to Rite Aid stockholders.”...Rite Aid chairman and CEO John Standley said that despite believing in the merits of the merger, it had listened to its stockholders and has committed to moving forward as a standalone company...

Nebraska is preparing to carry out its first execution since 1997 on Tuesday in a bewildering about-face driven largely by the state’s Republican governor...Carey Moore, is scheduled to be executed at the Nebraska State Penitentiary...with a never-before-tried combination of drugs. Moore was condemned to die for the 1979 shooting deaths of...Maynard Helgeland and Reuel Van Ness Jr., and is one of the nation’s longest-serving death row inmates...The combination of drugs for Tuesday’s execution has never been used to put a person to death, according to the Lincoln Journal Star. Three of the drugs — diazepam, fentanyl and cisatracurium — have never been used as part of an execution protocol. The fourth drug, potassium chloride, has been challenged as having the potential to cause serious pain for the inmate.

Amgen made an aggressive legal bid to push Sanofi and Regeneron's rival PCSK9 drug off the market when the two were first duking it out in 2015. It didn't work—but Amgen hasn't given up. It's aiming to take the battle to the U.S. Supreme Court instead...After falling short with its arguments in federal appeals court, Amgen is asking the Supreme Court to strike up a review of the case. Amgen claimed Sanofi and Regeneron stepped on its PCSK9 patents and initially won an injunction against their drug Praluent...Amgen now argues that the U.S. Court of Appeals for the Federal Circuit incorrectly interpreted and ruled on patent law. The company says the court has created its own standard that has resulted in “jurisprudential anarchy.” Amgen markets the PSCK9 cholesterol drug Repatha in a head-to-head battle with Praluent; both products have fallen short of expectations, mostly because payers limited access to the high-priced drugs.

For many public health experts, Massachusetts’ near-universal health insurance coverage makes it the gold standard for access to care…the industrial cities of Lowell and Lawrence...have both seen a surge in new HIV cases among people who use intravenous drugs...Between 2015 and 2018, there were 129 new HIV cases linked to drug use in the two cities...By comparison, from 2012 to 2014, an average of just 41 cases of HIV linked to injection drug use were diagnosed per year in the entire state of Massachusetts...local stakeholders told investigators that Lawrence had a local illegal fentanyl manufacturing operation, which made the synthetic opioid ― an efficient vector for HIV because its short high leads to more frequent injections ― both pervasive and cheap. Meanwhile, rampant homelessness disrupted treatment for those most at risk. And even though community leaders in Lawrence and Lowell pushed for clean needle exchanges, a known method for stopping infectious disease spread, they only did so after the outbreak began...As fentanyl spreads across the U.S. and drug use patterns evolve, other areas of the country with this same constellation of risk factors should take note.

The Washoe County School District is poised to renew a contract...with Renown Hospital and its insurance arm to provide health care to teachers and other district employees, but the hospital’s biggest competitor, Saint Mary’s Regional Medical Center, is crying foul over the process, saying it can provide care more cost-effectively and wasn’t given a fair shot to prove it can do so...Saint Mary’s Health Network, which includes the hospital, other health-care facilities and networked providers, submitted a proposal to the school district earlier this summer for a comprehensive health plan that it says could have saved the district anywhere between $5.4 million and $15.9 million in 2019. But the school district rejected the proposal as “non-responsive” because the district had only requested information on hospital services, not a full health plan, adding in a letter that it only sent out the bid in the first place in response to “constant badgering and lobbying” by Saint Mary’s.

This new approval pathway was created to expedite the development and review of a generic drug for products that lack competition...The FDA gave the nod for Apotex’s potassium chloride oral solution...“Today’s approval marks the successful implementation of a new program designed to encourage generic drug development for products with inadequate generic competition,” said FDA commissioner Scott Gottlieb, in a press statement...“The quick implementation of this new pathway is part of our broader effort to foster generic competition and help address the high cost of drugs. So are our efforts to narrow the time it takes for generic drugs to reach the market by reducing the number of review cycles that generic applications typically undergo. This new generic drug application was also approved in its first cycle of review. This approval demonstrates that the competitive generic therapy pathway is efficient and open for business. This pathway is a key step in making safe and effective generic drugs available to patients quickly and ensuring there’s adequate competition so patients have affordable access to the treatments they need,” said Gottlieb.

Nicole Grassano, PTNN, Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.