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The Trump administration...finalized a rule meant to make it easier for state Medicaid programs, commercial insurers and drugmakers to enter into "value-based" arrangements tying prescription drug payments to clinical outcomes... The rule overhauls existing regulations...Under these types of deals, payers negotiate prices with drugmakers based on outcomes and evidence-based measures like reduced hospitalizations or lab visits, and aren't accountable for the full price if those measures aren't met...CMS estimates that value-based drug deals emerging in the wake of the final rule could save federal and state governments up to $228 million through 2025...READ MORE

The head of Centers for Medicare & Medicaid Services reiterated support for Medicaid work requirements as enrollment in the program swells this year...CMS Administrator Seema Verma spoke about work requirements...Her remarks come less than a month after a study in Health Affairs found that work requirements in Arkansas did not lead to more employment...“I am supportive of states making decisions about their programs and deciding what has worked best,” Verma said...She added that 20 states have been interested in the work requirements program...CMS has approved waivers for 10 states but currently no states are running a work requirement program. Arkansas, Indiana, Michigan and New Hampshire all started work requirement programs, but court rulings struck them down. Utah implemented its work requirement program in January, but it was suspended in April due to COVID-19...Verma said that the goal of the programs were to help improve the health of able-bodied Medicaid beneficiaries...READ MORE

Insurers are worried a raft of proposed changes to the Medicaid Drug Rebate Program could lead to drug manufacturers gaming the system to charge higher prices...Several insurer groups commented on the proposed rule that the Centers for Medicare & Medicaid Services released last month to get states and drugmakers to create more value-based payment arrangements...If finalized, the rule would relax some of the requirements for the average manufacturer price and best price that manufacturers must provide for Medicaid. Under the new rule, a manufacturer could report multiple best prices for a therapy under the Medicaid Drug Rebate Program, but any best price has to be tied to a value-based purchasing agreement...READ MORE

Anthem faces a federal lawsuit for submitting inaccurate diagnostic data to get a higher Medicare reimbursement...The U.S. Attorney for the Southern District of New York said in the lawsuit...that Anthem failed to find and delete inaccurate diagnosis codes from 2014 to early 2018 through its “chart review program,”...“By ignoring its duty to delete thousands of inaccurate diagnoses, Anthem unlawfully obtained and retained from [Centers for Medicare & Medicaid Services] millions of dollars in payments under the risk adjustment payment system for Medicare Part C,” the lawsuit said...READ MORE

A new Aetna pilot program aims to harness its parent company's pharmacy reach to help address members' social needs...Through the HealthTag initiative, CVS Health pharmacists and pharmacy employees are empowered to offer more personalized information when Aetna Medicaid members come to pick up prescriptions, providing the members with health information beyond how to take their medications appropriately...Inside the prescription bag, members are provided additional details on how to access community services to address social concerns like food, housing or transportation. The network of these organizations is backed by Unite Us, a social care coordination program...Aetna will pilot the program at CVS pharmacies in West Virginia and Louisiana...READ MORE

Hospital groups praised the Trump administration's decision Monday to pull a Medicaid rule aimed at fiscal accountability, which providers warned could lead to massive cuts in reimbursement..."up to $50 billion in annual funding for the Medicaid program was on the line" if the rule had been finalized..."We appreciate CMS for acknowledging the harmful consequences this rule would have for patients,"..."Hospitals and health systems will be greatly relieved when the proposed rule is formally withdrawn."...The Centers for Medicare & Medicaid Services first unveiled the Medicaid Fiscal Accountability Rule in November, with the goal of tamping down on schemes used by states to boost federal matching funds in the program...READ MORE

The Department of Health and Human Services will dole out another $25 billion in funding targeted at healthcare providers that primarily serve Medicaid and low-income patients...The agency will distribute $15 billion to providers that participate in Medicaid and CHIP programs, and another $10 billion to safety-net hospitals...The funds are intended to help hundreds of thousands Medicaid providers that did not receive funding through the general distribution that went out to providers in April and May...Safety-net hospitals, which provide a significant proportion of care to uninsured and low-income patients, will be able to receive between $5 million and $50 million. HHS said it plans to distribute the funds to hospitals this week...READ MORE

...uninsured Nevadans can enroll for health coverage on the state-operated exchange, which this year features more carriers and plans...Insurance plans are available through online marketplace Nevada Health Link to those who don’t qualify for Medicaid or Medicare or don’t have insurance through an employer...“I don’t think that it comes as any surprise to anybody during this COVID era, there’s never been a more important time to connect to comprehensive health care,” Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said...The 50 plans on the exchange, nearly twice as many as last year, cover COVID-19-related testing and diagnosis, she said. They are all so-called qualified health plans that encompass the 10 essential health benefits, including coverage of pre-existing conditions, mandated by the Affordable Care Act. Dental and vision plans also are available...READ MORE

Hospitals say revenue from the 340B program is essential, while others contend the original law is being abused...an federal appeals court ruled that 340B hospitals will now be subject to Medicare cuts in outpatient drug payments by nearly 30%... gives...the Department of Health and Human Services the legal authority to reduce payment for Medicare Part B drugs to 340B hospitals...the action means patients – particularly those who live in vulnerable areas – will pay less out-of-pocket for drugs in the Medicare Part B program...providers...said the 340B decision will hurt hospitals and patients in these vulnerable areas...Hospitals that serve large numbers of Medicaid, Medicare and uninsured patients were getting the drugs for a discounted price, but, getting reimbursed at the higher price...The hospitals...are in the red or operating on thin margins, were using the pay gap in the price difference to cover operational expenses. HHS deemed it inappropriate that these facilities would use Medicare to subsidize other activities and initiatives...READ MORE

...the Centers for Medicare & Medicaid Services recently released their new projections for U.S. National Health Expenditures. Unfortunately, the coronavirus almost immediately made these predictions obsolete...It’s still useful to analyze these forecasts for a pre-pandemic examination of U.S. healthcare spending. A few highlights of the 2024 outlook: READ MORE

• Total U.S. spending on healthcare was projected to grow, from $3.6 trillion in 2018 to $5.0 trillion in 2024.
• Spending on hospitals and professional services was expected to grow by a combined $800 billion—more than 60% of CMS’s projected $1.4 trillion increase in U.S. healthcare spending. That’s consistent with historical trends.
• Net spending on outpatient prescription drugs in 2024 was projected to shrink to less than 9% of total U.S. spending. That would be its lowest level since 2000.