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Four people were injured and one woman was killed in a mass shooting Wednesday in a downtown Atlanta medical office waiting room, local law enforcement said...The suspected gunman, a 24-year-old man, entered Midtown medical building and shot the victims around noon, police said. He escaped in a stolen vehicle, kicking off a manhunt before he was taken into custody without incident later that evening, they said...The victim who was killed has been identified as Amy St. Pierre, a 39-year-old who worked for the Centers for Disease Control and Prevention, according to a statement from the agency...READ MORE

The main U.S. drug lobby has said it will push back against the legislation, which includes policies that drugmakers have opposed for decades...The pharmaceutical industry is gearing up to minimize the effect of major drug legislation passed by Congress on Friday, the first time in many years lawmakers have overcome the drug lobby’s opposition to limits on their pricing power...the House of Representatives passed the Inflation Reduction Act in a 220-207 party-line vote, sending the bill to President Joe Biden...The bill would allow Medicare to negotiate prices on up to 60 drugs by 2029...The pharma industry spent heavily to lobby against the bill and, after decades of forestalling action to curtail the industry’s pricing power in the U.S., its main lobbying group signaled the fight would continue...READ MORE

The Biden administration has officially pulled a controversial model that would have tied prices for drugs reimbursed under Part B to prices paid by countries overseas...The Centers for Medicare & Medicaid Services issued a final rule last week that pulls the demonstration approved at the tail end of the Trump administration. Providers had slammed the Most Favored Nation model due to concerns over reimbursement...CMS said in the final rule published on Dec. 29 that the model sparked four lawsuits from the drug industry, which resulted in a legal stay delaying it from going into effect...READ MORE

The Association for Accessible Medicines’ latest report found that Medicare Part D plans are slow to add new generics to their formularies and often place them on nongeneric pricing tiers...Medicare Part D plans are slower than commercial plans to adopt new generics, and even when adopted, the generics are less likely to be part of a generic cost tier. That’s according to a new report from the Association for Accessible Medicines that examines the speed of first generics entering formulary coverage for both Medicare Part D plans and commercial plans...READ MORE

Rep. Lauren Underwood, D-Illinois, and Sen. Dick Durbin, D-Illinois, wrote a letter to CMS Administrator Chiquita Brooks-LaSure...calling out CMS to use new funding and existing authority to expand Medicare coverage. The letter comes amid rising rates of addiction deaths exacerbated in part by the pandemic...While Medicare does cover low-intensive levels of substance use disorder like therapy and high levels of care such as inpatient treatment, experts and advocates worry that CMS does not cover the full continuum of care for beneficiaries...READ MORE

The econowonks at the Centers for Medicare & Medicaid Services recently released the latest projections for U.S. spending on healthcare. These data provide our first official look at post-pandemic U.S. healthcare spending...As you will see below, outpatient prescription drugs dispensed by retail and mail pharmacies are projected to remain a small share (8.4%) of total U.S. healthcare spending. What’s more, taxpayers—via Medicare and Medicaid—will continue to crowd out the private insurance market. One bright spot: consumers will account for an ever-smaller share of drug spending...READ MORE

Today, I examine how smaller pharmacies will participate as preferred cost sharing pharmacies via the pharmacy services administrative organizations that represent them in negotiations with plans...the largest PSAOs are increasingly rejecting preferred networks. Below we provide details about the PSAOs owned by the three major wholesalers—AmerisourceBergen, Cardinal Health, and McKesson—along with information about AlignRx, the largest independent PSAO. There are some notable differences in strategy, as you will see from our handy scorecard below...Smaller pharmacies’ rejection of Part D preferred networks shows that they are figuring out how to survive a highly challenging retail environment. Perhaps Part D is just a flesh wound?...READ MORE

A mother and her daughter have been indicted on health care fraud charges after they allegedly received millions in false Medicare claims...Mirosis Gonzalez...and her daughter Berioska Sosa...used the pharmacy they owned and operated, Aviva Care Pharmacy, to submit over $12 million in false Medicare claims...received payments totaling about $8.4 million...The marketing and telemedicine companies recruited patients and referred Medicare beneficiaries and doctors’ orders and prescriptions to Aviva Care Pharmacy and were paid kickbacks and bribes in return...the companies sent Aviva orders, which the pharmacy accepted...“without considering medical necessity or Medicare reimbursement eligibility.”...They are accused of disguising the kickbacks and bribes they paid to these companies by saying the payments were for marketing and other services...READ MORE</strong>

The Centers for Medicare & Medicaid Services has recently released its 2022 data on enrollment in Medicare Part D prescription drug plans. Our exclusive analysis of these numbers finds that for 2022, an astounding 99% of seniors are enrolled in the wonderland of PDPs with preferred pharmacy networks...For the second year, the big supermarket chains—Albertsons, Kroger, and Publix—outpaced the big three drugstore chains and Walmart...
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The Biden administration has delayed enforcement of key parts of a major insurer price transparency rule by six months until July 1, 2022, to give plans more time to comply...The Centers for Medicare & Medicaid Services announced the change in a new guidance released Friday focusing on the final price transparency rule released last October under the Trump administration. The guidance focuses on a requirement that certain health plans disclose online their in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for certain items and services...READ MORE